控制性低血压联合血液稀释对胃黏膜内pH值的影响。

Effect of controlled hypotension combined with hemodilution on gastric intramural pH.

作者信息

Fukusaki M, Hara T, Maekawa T, Nakamura T, Cho S, Sumikawa K

机构信息

Department of Anesthesia, Nagasaki Rosai Hospital, Sasebo, Japan.

出版信息

J Clin Anesth. 1998 May;10(3):222-7. doi: 10.1016/s0952-8180(98)00010-5.

DOI:10.1016/s0952-8180(98)00010-5

PMID:9603592

Abstract

STUDY OBJECTIVE

To evaluate the effect of controlled hypotension combined with hemodilution on gastric intramural pH in the clinical setting.

DESIGN

Randomized, prospective study.

SETTING

Inpatient surgery at Nagasaki Rosai Hospital.

PATIENTS

30 ASA physical status I and II patients scheduled for total hip arthroplasty.

INTERVENTIONS

Patients were randomly divided into two groups. Group A (n = 15) received controlled hypotension with mild hemodilution. Group B (n = 15) received controlled hypotension with moderate hemodilution. Hemodilution was carried out after induction of anesthesia. Drawn blood was replaced with 6% hydroxyethyl starch solution. Final hematocrit values were 32 +/- 2% (mean +/- SD) in Group A and 23 +/- 2% in Group B. Controlled hypotension was induced with prostaglandin E1 (PGE1) to maintain mean arterial blood pressure at 55 mmHg for 80 minutes.

MEASUREMENTS AND MAIN RESULTS

Measurements included gastric intramural pH (pHi), arterial blood pH (pHa), and plasma lactate. These indices were measured before hemodilution, after hemodilution, 80 minutes after starting hypotension, 60 minutes after recovery from hypotension, and on the first postoperative day. The value of pHi was measured by tonometry. The pHa and lactate values showed no change in either Group A or Group B throughout the time course. Gastric pHi values showed no change in Group A throughout the time course. The pHi value in Group B showed a significant decrease from 7.420 +/- 0.028 to 7.339 +/- 0.034 (p < 0.05) after hemodilution, while it showed no further decrease at 80 minutes after starting hypotension (7.331 +/- 0.039) and 60 minutes after recovery from hypotension (7.330 +/- 0.048).

CONCLUSION

The results suggest that moderate hemodilution, such as 23% of hematocrit value, might impair oxygenation in gastrointestinal mucosa, whereas controlled hypotension induced by PGE1 combined with the hemodilution would not increase this impairment.

摘要

研究目的

评估控制性低血压联合血液稀释在临床环境中对胃黏膜内pH值的影响。

设计

随机、前瞻性研究。

地点

长崎罗萨医院住院手术。

患者

30例计划行全髋关节置换术的ASA身体状况I级和II级患者。

干预措施

患者随机分为两组。A组（n = 15）接受轻度血液稀释的控制性低血压。B组（n = 15）接受中度血液稀释的控制性低血压。血液稀释在麻醉诱导后进行。抽取的血液用6%羟乙基淀粉溶液替代。A组最终血细胞比容值为32±2%（均值±标准差），B组为23±2%。用前列腺素E1（PGE1）诱导控制性低血压，将平均动脉血压维持在55 mmHg 80分钟。

测量指标及主要结果

测量指标包括胃黏膜内pH值（pHi）、动脉血pH值（pHa）和血浆乳酸。这些指标在血液稀释前、血液稀释后、低血压开始后80分钟、低血压恢复后60分钟以及术后第一天进行测量。pHi值通过张力测定法测量。在整个时间过程中，A组和B组的pHa和乳酸值均无变化。A组的胃pHi值在整个时间过程中无变化。B组的pHi值在血液稀释后从7.420±0.028显著降至7.339±0.034（p<0.05），而在低血压开始后80分钟（7.331±0.039）和低血压恢复后60分钟（7.330±0.048）未进一步下降。