目的探讨每搏量变异度(SVV)在评估心功能不全患者和正常心功能患者中对容量负荷的反应能力有无差异。方法采用前瞻性研究方法,纳入首都医科大学附属北京友谊医院2015年1月至2016年5月择期行非停跳冠状动脉旁路移植术(CABG)的患者27例,腰椎管狭窄椎弓根钉内固定术患者25例,设为心功能异常组(A组)和心功能正常组(B组)。常规麻醉诱导后20 min连续恒速输注500 ml 6%羟乙基淀粉130/0.4氯化钠注射,观察记录输注液体前后SVV、每搏量(SV)、基于动脉压力波形的心排血量(APCO)、心率(HR)、平均动脉血压(MAP)。由Flo Trac/Vigileo系统计算获得容量负荷前后SV差值(△SV)≥10%为容量负荷后有反应,反之为无反应。结果容量负荷前后A组SVV及B组HR、SV、SVV比较差异有统计学意义(P<0.05);A组HR、MAP、APCO、SV前后比较差异无统计学意义(P>0.05);B组MAP、APCO前后比较差异无统计学意义(P>0.05)。两组反应性为:A组有反应者10例,无反应者17例;B组分别有反应者20例,无反应者5例。A组SVV基础值、△SVV(SVV变化值)与△SV(容量负荷前后SV差值)相关系数分别为:r1=0.436、r2=-0.542;B组的SVV基础值、△SVV与△SV的相关系数为:r1=0.454、r2=0.497;SVV基础值和△SVV与△SV存在直线负相关,两组回归直线差异无统计学意义(P>0.05)。结论每搏量变异度可以预测容量负荷反应能力,在心功能异常和心功能正常患者间无显著差异,均能及时、有效地指导容量治疗。
Objective: To evaluate the influence of preoperative moderate acute normovolemic hemodilution (ANH) with 6% hydroxyethyl starch(HES,200/0.5) on blood coagulation.Methods: Twenty ASA Ⅰ-Ⅱ patients scheduled for elective surgery were randomly assigned to receive moderate ANH with 6% HES.After induction of general anesthesia blood was withdrawn and collected before the onset of surgical blood loss,and at the same time replaced with HES.Measurements were obtained before and 15min after hemodilution and retransfusion of autologous blood.Results: After hemodilution APTT and PT were prolonged respectively from 30.50±4.50s and 12.66±1.03s to 34.48±3.62s and 14.14±0.86s(P<0.01).After retransfusion both of them could be used to normal range(P<0.01).Activated clotting time(ACT) had no changes all the while(P>0.05).After hemodilution both Fib and CR decreased significantly(P<0.01).Both of them increases significantly after retransfusion(P<0.01).Plt after hemodilution is less than that of before hemodilution significantly(P<0.01).PF decreased significantly(P<0.01) and TP was significantly(P<0.01) prolonged after hemodilution.Plt,PF and TP were resumed to a great extent(P<0.01).Conclusions: There was influence to some extent of moderate ANH with 6% HES on the function of coagulation.And platelet function could be shielded in ANH.
