临床麻醉学杂志：术中应用羟乙基淀粉维持血容量血浆胶体渗透阳压的变化.docVIP

术中应用羟乙基淀粉维持血容量血浆胶体渗透压的变化 摘要 目的 观察非体外循环冠状动脉旁路移植术（OPCAB）中输注6%羟乙基淀粉130/0.4（万汶）血浆胶体渗透压（COP）的变化。方法 选择34例行OPCAB手术的患者(NYHAⅠ～Ⅱ)，麻醉诱导时开始输注万汶至血管吻合完毕，总量控制为25～30 ml·kg-1。分别于万汶输注前(T0)、离断乳内动脉后(T1)、桥血管吻合完毕时(T2)监测血浆COP，观察血流动力学，记录输液量，失血量，血红蛋白（Hb），红细胞比积（Hct）和心脏指数（CI）。结果 手术过程血流动力学稳定，T0、T1、T2三个时段的COP均在正常值范围。T1失血量为120?30 ml，输注万汶998?110 ml，血浆COP由T0的21.7?1.4 mmHg升至22.3?1.3 mmHg (p0.05)；T2时段失血量为778?179 ml，输注万汶2190?135 ml，血浆COP降至21.5?1.4 mmHg，与T0相比不具有显著性差异(p0.05)。T2时段的Hb和Hct比T0下降明显(p0.05)，但仍保持在安全范围。T2时段的CI比T0有显著提高(p0.05)。结论 失血量低于10.9 ±1.2% 血容量时，输注万汶27.9?2.5 ml·kg-1，血浆COP相对恒定。 关键词 6%羟乙基淀粉130/0.4；血浆胶体渗透压COP；非体外循环冠状动脉旁路移植术OPCAB 刘扬 首都医科大学北京朝阳医院麻醉科， 邮编100020 Changes of plasma colloid osmotic pressure after hydroxyethyl starch infusion during operation LIU Yang ZHANG Yong-qian WU Di YUE Yun Abstrct Objective The effects of 6% hydroxythyl starch 130/0.4 (voluven) infusion on plasma colloid osmotic pressure (COP) were studied in patients during off-pump coronary artery bypass (OPCAB) surgery. Methods Thirty four patients (NYHAⅠ～Ⅱ) underwent OPCAB were infused with voluven at a dose of 25～30 ml·kg-1 from induction of anaesthesia until the end of bypass. We determined COP at beginning of infusion (T0), after the transsection of artery (T1) and at the end of bypass (T2). Hemodynamics, requirement for voluven, blood loss, Hb，Hct and cardiac index (CI) were record consequently. Results Circulatory conditions were generally stable during operation. In three measurement points, the COP were always within the normal range. At T1, patients received 998?110 ml of Voluven, the loss of blood was 120?30 ml, the COP increased significantly compared to T0 (p0.05): from 21.7? 1.4 mmHg to 22.3? 1.3 mmHg; At T2, patients received a totle of 2190 ?135 ml of Voluven, the loss of blood was 778?179 ml, the COP decreased to 21.5? 1.4 mmHg. It was similar at both T0 and T2 (p0.05). Hb and Hct were always within normal range, but decreased significantly at T2 compared to T0 (p0.05). CI were higher at T2 than T0 (p0.05)