不同液体进行轻度急性等容性血液稀释对腰椎融合术患者血流动力学、血气及血栓弹力图指标的影响

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摘要目的探讨不同液体进行轻度急性等容性血液稀释（ANH）对腰椎融合术手术患者血流动力学、血气及血栓弹力图指标的影响。方法选取2017年8月～2019年12月华中科技大学协和深圳医院择期全身麻醉下行腰椎融合术的50例患者作为研究对象。采用随机数字表法将患者分为羟乙基淀粉组和复方氯化钠组，每组各25例。分别以羟乙基淀粉130/0.4 与复方氯化钠溶液行ANH，稀释后预计血细胞比容为30%。观察两组患者在血液稀释前后血流动力学、血气及血栓弹力图各项指标的变化。结果两组患者轻度ANH 前5 min（T1）、轻度ANH后15 min（T2）时刻的血氧饱和度（SpO2）、心率（HR）、平均动脉压（MAP）比较，差异均无统计学意义（P＞0.05）；两组患者T2时刻的SpO2、HR、MAP 与T1时刻比较，差异均无统计学意义（P＞0.05）；在血栓弹力图各项指标中，羟乙基淀粉组患者T2时刻的K值高于复方氯化钠组，Angle角低于复方氯化钠组，差异有统计学意义（P＜0.05）；羟乙基淀粉组患者在T2时刻的反应时间（R）值高于本组T1时刻，Angle角低于本组T1时刻，差异有统计学意义（P＜0.05）；羟乙基淀粉组T2时刻的凝固时间（K）值、最大血块强度（MA）值与本组T1时刻比较，差异均无统计学意义（P＞0.05）；复方氯化钠组在T2时刻的R值、K值低于本组T1时刻，差异有统计学意义（P＜0.05）；复方氯化钠组T2时刻的Angle角高于本组T1时刻，差异有统计学意义（P＜0.05）；复方氯化钠组T2时刻的MA值与本组T1时刻比较，差异无统计学意义（P＞0.05）；两组患者T2时刻的pH值与本组T1时刻比较，差异无统计学意义（P＞0.05）；两组患者T2时刻的血细胞比容均低于本组T1时刻，差异有统计学意义（P＜0.05）；羟乙基淀粉组T2时刻的乳酸水平低于本组T1时刻，差异有统计学意义（P＜0.05）；复方氯化钠组T2时刻的乳酸水平与T1时刻比较，差异无统计学意义（P＞0.05）。结论进行轻度ANH，使用羟乙基淀粉130/0.4 与复方氯化钠均不会对患者血流动力学造成明显影响。使用羟乙基淀粉130/0.4 会使患者凝血功能向低凝方向改变，使用复方氯化钠会使患者凝血功能向高凝方向改变，使用羟乙基淀粉130/0.4后，患者乳酸水平降低。

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	朱海涛
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关键词 ：轻度急性等容性血液稀释, 血栓弹力图, 羟乙基淀粉, 低凝, 复方氯化钠, 高凝, 血乳酸

Abstract：Objective To investigate the effect of mild acute normovolemic hemodilution (ANH) with different fluids on indicators of hemodynamics, blood gas and thrombelastogram indicators of lumbar spinal fusion patients.Methods A total of 50 patients who underwent lumbar spinal fusion under general anesthesia in Huazhong University of Science and Technology Union Shenzhen Hospital from August 2017 to December 2019 were selected as the research subjects.The patients were divided into the hydroxyethyl starch group and the compound sodium chloride group by the random number table method, with 25 patients in each group.The two groups were treated with Hydroxyethyl Starch 130/0.4 and Compound Sodium Chloride Solution for ANH, respectively, and the hematocrit was expected to be 30% after dilution.The changes of indicators of hemodynamics, blood gas and thrombelastogram of patients in the two groups were observed before and after blood dilution.Results There were no significant differences in blood oxygen saturation(SpO2), heart rate (HR) and mean arterial pressure (MAP) 5 min before mild ANH (T1) and 15 min after mild ANH (T2)between the two groups (P＞0.05).There were no statistically significant differences in SpO2, HR and MAP at T2 in the two groups compared with those at T1 (P＞0.05).Among the indicators of thromboelastic diagram, K value at T2 in the hydroxyethyl starch group was higher than that in the compound sodium chloride group, and Angle was lower than that in the compound sodium chloride group, the differences were statistically significant (P＜0.05).The reaction time (R)value of the hydroxyethyl starch group at T2 was higher than that at T1, and its Angle was lower than that at T1, with statistical significance (P ＜0.05).There were no significant differences in coagulation time (K) and maximum clot strength (MA) at T2 in the hydroxyethyl starch group compared with those at T1 (P＞0.05).The R value and K value of the compound sodium chloride group at T2 were lower than those at T1, and the differences were statistically significant(P＜0.05).The Angle at T2 in compound sodium chloride group was higher than that at T1 in this group, and the difference was statistically significant (P＜0.05).There was no significant difference in MA value at T2 in the compound sodium chloride group compared with that at T1 (P＞0.05).There was no significant difference in the pH value at T2 of the two groups compared with that at T1 (P＞0.05).The hematocrit at T2 in the two groups was lower than that at T1, with statistical significance (P＜0.05).The level of lactic acid at T2 in the hydroxyethyl starch group was lower than that at T1,and the difference was statistically significant (P＜0.05).There was no significant difference between the lactate level at T2 and T1 in the compound sodium chloride group (P＞0.05).Conclusion In mild ANH, the uses of Hydroxyethyl Starch 130/0.4 and Compound Sodium Chloride do not significantly affect the hemodynamics of the patients.The use of Hydroxyethyl Starch 130/0.4 will direct the coagulation function of the patients to hypocoagulability, while the use of Compound Sodium Chloride will direct the coagulation function to hypercoagulability.The lactic acid level can be reduced after the use of Hydroxyethyl Starch 130/0.4.

Key words： Mild acute normovolemic hemodilution Thrombelastogram Hydroxyethyl Starch Hypocoagulability Compound Sodium Chloride Hypercoagulability Blood lactic acid

基金资助:广东省深圳市南山区技术研发和创意设计项目分项资金教育（卫生）科技资助项目（南科研卫2017010号）

引用本文:

朱海涛；王丹丹；奉光举. 不同液体进行轻度急性等容性血液稀释对腰椎融合术患者血流动力学、血气及血栓弹力图指标的影响[J]. 中国当代医药, 2021, 28(8): 18-22转26.
ZHU Hai-tao ；WANG Dan-dan； FENG Guang-ju. Effect of mild acute normovolemic hemodilution with different fluids on indicators of hemodynamics, blood gas and thrombelastogram indicators of lumbar spinal fusion patients. 中国当代医药, 2021, 28(8): 18-22转26.

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http://dangdaiyiyao.com/CN/ 或 http://dangdaiyiyao.com/CN/Y2021/V28/I8/18

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