国际医药卫生导报2018，Vol.24Issue(7)：972-976,980,6.DOI:10.3760/cma.j.issn.1007-1245.2018.07.005
低中心静脉压联合急性高容量血液稀释在胸科手术中的应用
The application of low central venous pressure combined with acute hypervolemic hemodilution in thoracic surgery
摘要
Abstract
Objective To investigate the effect of low central venous pressure (LCVP) combined with acute hypervolemic hemodilution (AHHD) on intrapulmonary shunt and arterial oxygen partial pressure during one lung ventilation in thoracic surgery.Methods 50 thoracic surgery patients with ASA grade Ⅰ-Ⅱ undergoing elective radical resection of lung cancer were randomly divided into 2 groups:LCVP combined with AHHD group (LA group) and control group (C group),25 cases in each group.LA group received LCVP technology immediately after anesthesia with the methods of limited amount of crystalloid infusion and continuous micro pump injection of nitroglycerin,with intraoperative CVP in 2～5 cmH2O,and then received AHHD technology with rapid infusion of 6％ hydroxyethyl starch (130/0.4) 15 ml/kg,with Hot at 25％～30％.Intraoperative CVP in C group was maintained at the normal level (6～12 cmH2O).The blood glucose (GLU) and cortisol (COR) levels were measured by collecting the elbow venous blood at 10 min after double lung ventilation in the horizontal position (T0),10 min after one lung ventilation in the horizontal position (T1),10 min after one lung ventilation in the lateral position (T2),10 min after pulmonary lobectomy (T3).The radial artery blood and right atrial mixed venous blood were collected for blood gas analysis;and recorded GLU,COR level,SpO2,HR,MAP,CVP,BIS,PetCO2,arterial oxygen content (CaO2),mixed venous oxygen content (CvO2),arterial and mixed venous blood oxygen partial pressure (PO2),arterial and mixed venous blood oxygen saturation of hemoglobin (SO2),arterial and mixed venous blood hemoglobin (Hb).The rate of intrapulmonary shunt (Qs/Qt) was calculated according to the standard three compartment model of pulmonary blood tlow distribution [Qs/Qt =(CcO2-CaO2)/(CcO2-CvO2)×l00％].Results The GLU,COR level,SpO2,HR,MAP,CVP,BIS,PetCO2 of the two groups at each time point were basically stable,but intrapulmonary shunt significantly increased in both LA group and C group after one lung ventilation (P＜0.05),which increased by 13.7％ and 14.9％ respectively in the horizontal position,11.4％ and 14.3％ respectively in the lateral position.The arterial oxygen partial pressure significantly decreased in both LA group and C group (P＜0.05),that in the horizontal position decreased more obviously compared with the lateral position,but without statistically significant difference between the two groups (P＞0.05).After lobectomy,the intrapulmonary shunt in LA group and C group significantly reduced (P＜0.05),which increased by 7.2％ and 8.6％ respectively;the arterial oxygen partial pressure increased significantly in both two groups (P＜0.05),but without statistically significant difference between the two groups (P＞0.05).The proportion of blood transfusion in group LA was significantly lower than that in group C (4％ vs.28％,x2=4.902 0,P=0.039 5).Conclusion Low central venous pressure combined with acute hypervolemic hemodilution has no significant inhibition on intrapulmonary shunt and arterial oxygen partial pressure during one lung ventilation during thoracic surgery,and can significantly reduce the proportion ofintraoperative blood transfusion.关键词
低中心静脉压/急性高容量血液稀释/胸科手术/肺内分流/动脉氧分压Key words
Low central venous pressure/Acute hypervolemic hemodilution/Thoracic surgery/Pulmonary shunt/Oxygen partial pressure引用本文复制引用
胡峥嵘,魏兵华,李长科,谭江波,吴勤如..低中心静脉压联合急性高容量血液稀释在胸科手术中的应用[J].国际医药卫生导报,2018,24(7):972-976,980,6.基金项目
2015年广东省韶关市医药卫生科研计划项目(Y15054)Medicine and Health Scientific Research Project of Shaoguan City of Guangdong Province in 2015 (Y15054) （Y15054）
