晶体和胶体溶液用于麻醉诱导后容量负荷治疗效果的比较

Treatment Outcome of Crystalloids Versus Colloids for Optimization After Induction of General Anesthesia

关键词:  乳酸林格氏液  羟乙基淀粉130/0.4  容量负荷  每博心脏输出量指数  血容量扩张效率

Key words:  Ringer's lactate solution  hydroxyethyl starch 130/0.4  fluid optimization  stroke volume index  blood volume expansion efficiency

摘要:

目的 探讨乳酸林格氏液和羟乙基淀粉130/0.4容量负荷治疗的效果。方法 本研究为双盲前瞻性研究。选择2011年7月-2013年3月择期胃肠外科肿瘤手术患者81例，美国麻醉医生分级Ⅰ~Ⅱ，分成2组：Ⅰ组（羟乙基淀粉130/0.4容量负荷组，n=56）和Ⅱ组（乳酸林格氏液容量负荷组，n=25）。麻醉诱导后予以3次容量负荷，每次3 mL·kg^-1羟乙基淀粉130/0.4或者乳酸林格氏液，7 min输毕。麻醉前后、每次容量负荷后稳定5 min，记录平均动脉压（MAP）、每博心脏输出量指数（SVI）、血容量扩张效率和氧供（DO₂）。结果 麻醉诱导期间SVI和MAP均降低，两组相当；Ⅰ组和Ⅱ组患者对3次容量负荷的反应性分别为64%对20%（P<0.001）、43%对13%（P<0.001）和23%对14%（P=0.101）；而第1或2次容量负荷后Ⅰ组患者达到容量最优化的累计比例低于Ⅱ组（25%对74%，P<0.001；46%对81%，P<0.001），第3次2组差异无统计学意义（88%对89%，P=0.825）。3次容量负荷后SVI上升的幅度Ⅰ组（基础值86%）高于II组（基础值68%）（P<0.001），而MAP变化2组差异无统计学意义。第1次负荷后2种液体的血容量扩张效率相当，第2次和第3次负荷Ⅰ组高于Ⅱ组。麻醉诱导和血液稀释均导致氧供下降，2种液体之间没有区别。结论 容量优化治疗中胶体液的容量治疗效果优于晶体液，建议采用胶体液进行容量负荷治疗。

Abstract:

OBJECTIVE To evaluate the therapeutic effects for volume optimization between Ringer's lactate and hydroxyethyl starch 130/0.4 after induction of general anesthesia.METHODS It was a prospective double-blinded study. Between July 2011 and March 2013, 81 patients with American Society of Anesthesiologist physical status Ⅰ-Ⅱ scheduled for gastrointestinal cancer surgery were divided into 2 groups:Group Ⅰ (Bolus with hydroxyethyl starch 130/0.4, n=56) and Group Ⅱ (Bolus with Ringer's lactate, n=25). Three boluses of fluid infusion was with 3 mL·kg^-1 either hydroxyethyl starch 130/0.4 or Ringer's lactate over 7 min for each bolus. Mean arterial blood pressure (MAP), stroke volume index (SVI), blood volume expansion efficiency, and oxygen delivery (DO₂) were recorded pre-and-post induction of anesthesia, 5 min after each bolus infusion.RESULTS Induction of anesthesia decreased the SVI and MAP, which was comparable between the two groups. Responsiveness to three fluid boluses was 64% vs 20% (P<0.001), 43% vs 13% (P<0.001) and 23% vs 14% (P=0.101) respectively for patients in GroupⅠ and Ⅱ. At the same time, the cumulative percent of volume optimized post 1st or 2nd bolus in Group Ⅰ was lower than in Group Ⅱ (25% vs 74%, P<0.001 and 46% vs 81%, P<0.001), while post 3rd bolus it was similar between the two groups (88% vs 89%, P=0.825). Compared with the patients in Group Ⅱ (68% of baseline), SVI rose bigger in Group I (86% of baseline) (P<0.001) after three boluses, but the changes of MAP were comparable. Blood volume expansion efficiency in response to starch (Group I) exceeded to Ringer's solution (Group Ⅱ) after the 2nd or 3rd bolus, while after the 1st it was the same. DO₂ decreased both in response to the induction of general anesthesia and following the fluid induced plasma dilution, there was no difference between the two groups.CONCLUSION Colloid has an advantage over crystalloids for treatment of volume optimization, which suggests that colloid be used for volume optimization.