目的 观察急性高容量血液稀释(acute hypervolemic hemodilution,AHH)及其联合控制性降压(controlled hypotension,CH)对老年患者血乳酸(blood lactate,LAC)及氧化指标的影响,评价其可行性.方法 选择肝脏及胰十二指肠手术患者30例,估计出血量大于血容量的15%,65岁以上,ASAII级,随机分为2组,I组单纯AHH,在麻醉诱导后手术开始前以30 mL/min的速率输入6%羟乙基淀粉15mL/㎏,II组 AHH联合CH,在AHH同时以平均动脉压(mean arterial pressure,MAP)的70%为目标用尼卡地平行CH.连续监测血液动力学指标,分别于AHH前即刻(T0)、AHH完成即刻(T1)、完成后1h (T2)记录血红蛋白(hemoglobin,Hb)、红细胞比容(hematocrit,Hct),抽取混合静脉血测量丙二醛(malondialdehyde,MDA)和超氧化物歧化酶((superoxide dismutase,SOD),抽取动脉血测量LAC含量.结果 ①2组在T0各指标的差异无统计学意义(P>0.05);②血液稀释度变化,与T0相比,2组患者在T1 、T2的Hb、Hct均下降(P<0.05),2组Hb、Hct在各时间点比较差异均无统计学意义(P>0.05).③MDA、SOD、LAC变化,三者在组内各时点及组间相应时点差异均无统计学意义(P>0.05).结论 对于65岁以上、ASAII级、无明显心肺疾患的老年患者,单纯应用AHH及其联合尼卡地平行CH能满足机体氧耗的需求,是安全可行的,值得在临床推广.%Objective To investigate the effects of acute hypervolemic hemodilution (AHH) or AHH combined with controlled hypotension (CH) induced by nicardipine on oxidations and lactate in elderly patients , and evaluate the feasibility in clinical use.Methods This study included thirty ASA Ⅱpatients,aged 65～79, undergoing elective liver cancer, hepatic hemangioma or pancreas duodenum operations during which the blood loss were expected to be over 15％ of the patients' blood volume.Thirty patients were randomly divided into two groups, group Ⅰ AHH (n = 15 ) and group Ⅱ AHH combined nicardipine CH (n=15).In both groups compound sodium acetate injection was infused at a rate of 10mL/kg when the patient entered operation room.Six percent hydroxyethyl starch solution ( HES 200/0.5) 15mL/kg was infused at a rate of 30 mL/min before skin incision in the two groups.In group Ⅱ, as soon as AHH began , nicardipine was infused at a rate of 1 ～4 μg/kg-1 · min- 1 and maintained MAP at 70 ％ of the preoperative level.Hematocrit (Hct), hemoglobin ( Hb), malondialdehyde ( MDA),superoxide dismutase (SOD),were measured before AHH(T0), AHH completion (T1), 1h after AHH completion (T2).Results ①Two groups had no statistically signfiicant difference in regard to sex,age,body weight,height, types of operation and Hb, Hct, bispectral index(BIS).②Compared with the value at T0, Hct, Hb were decreased at T1, T2 in both groups; Compared with group Ⅰ, Hct, Hb had no statistically significant difference in group Ⅱ.③ As for MDA, SOD, LAC, there were no statistical significance during and after operation in both groups.Conclusion AHH or AHH combined with CH induced by nicardipine can keep the balance between oxygen delivery and oxygen consumption in elderly patients over 65.ASA Ⅱ and without obvious heart and lung diseases.The treatment is safe and worth popularizing in clinic.
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