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压的变化.docVIP

术中应用径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%軽乙基淀粉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(NYHA I -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 L分别于 万汶输注前(To)、离断乳内动脉后(TJ、桥血管吻合完毕时⑴)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(Het)和心脏指数(CI)。结果 手术过程血流动力学稳 定，To、T|、T2三个时段的COP均在正常值范围。口失血量为120±30 ml,输注万汶998±110 ml,血浆COP由T。的21.7±1.4 mmHg升至 22.3±1.3 mmHg (p0.05)； T?时段失血量为 778±179 ml,输注万汶ml,血浆COP降至2L5±l.4 mmHg,与T°相比不具有显著 性差异(p0.05)o T2时段的Hb和Het比To下降明显防0?05),但仍保 持在安全范围。T2时段的CI比To有显著提高(p0.05)o结论 失血量 低于10.9 ±1.2%血容量时，输注万汶27.9±2.5 ml-kg1,血浆COP相 对恒定。 关键词6%轻乙基淀粉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 Changes of plasma colloid osmotic pressure after hydroxyethyl starchinfusion 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 o毎pump coronary artery bypass (OPCAB) surgery. Methods Thirty four patients (NYHA I ?II ) underwent OPCAB were infused with voluven at a dose of 25 ?30 ml-kg1 from induction of anaesthesia until the end of bypass? We determined COP at beginning of infusion (T°), after the transsection of artery (TJ and at the end of bypass (T2)? Hemodynamics，requirement for voluven, blood loss, Hb, Het 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 Tb patients received 998±110 ml of Voluven, the loss of blood was 120±30 ml, the COP increased significantly compared to To (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 To and T2 (/?0.05). Hb and Het were always within normal range, but decreased significantly at T2 compared to To (p0.05). CI were higher at T2 than To (p0.05). Conclution When the