论文部分内容阅读
目的:评价心脏手术患儿6%羟乙基淀粉(HES)130/0.4急性血液稀释(AHD)后血钾浓度降低与6%HES130/0.4-人血清白蛋白(HSA)复合物的关系。方法:择期行室间隔或房间隔缺损修补术的患儿48例，性别不限，年龄2～12岁，体重12～53 kg，ASA分级Ⅱ或Ⅲ级。患儿气管插管术后以0.5 ml·kgn -1·minn -1的速率静脉输注10%血容量的6%HES130/0.4行AHD。于AHD前即刻和AHD结束后15、30 min时测定全血Kn ＋浓度。采用荧光光谱法分析6%HES130/0.4和HSA的结合关系。分别于加入Kn ＋前、加入Kn ＋后15和30 min时，测定HSA与6%HES130/0.4的结合常数。n 结果:与AHD前即刻比较，AHD结束后各时点Kn ＋浓度降低(n P<0.05)。荧光光谱分析法显示，6%HES130/0.4和HSA的Trp-214形成1∶1的复合物；与加入Kn ＋前比较，加入Kn ＋后15和30 min时结合常数降低。n 结论:心脏手术患儿6%HES130/0.4 AHD后血钾浓度一过性降低的机制可能与部分Kn ＋与HSA-6%HES130/0.4复合物形成“离子架桥”有关。n “,”Objective:To evaluate the relationship between decrease in potassium concentrations after acute hemodilution (AHD) with 6% hydroxyethyl starch (HES) 130/0.4 and 6% HES130/0.4 human serum albumin (HSA) complex in the pediatric patients undergoing cardiac surgery.Methods:Forty-eight pediatric patients of both sexes, aged 2-12 yr, weighing 12-53 kg, of American Society of Anesthesiologists physical statusⅡ-Ⅲ, undergoing elective surgical repair of ventricular or atrial septal defect, were included in this study.After tracheal intubation, 6% HES130/0.4 equivalent to 10% of the blood volume was intravenously infused at 0.5 ml·kgn -1·minn -1 to perform AHD.The Kn + concentration in whole blood was measured immediately before AHD and at 15 and 30 min after the end of AHD.The binding relationship between 6% HES130/0.4 and HSA was analyzed by fluorescence spectroscopy.The binding constants of HSA and 6% HES130/0.4 were determined before adding Kn + and 15 and 30 min after adding Kn + .n Results:The Kn + concentrations were significantly decreased at each time point after the end of AHD than those immediately before AHD (n P<0.05). Fluorescence spectra showed that 1∶1 complexation occurred between the 6% HES130/0.4 and Trp-214 of HSA.The binding constant was significantly decreased at 15 and 30 min after adding Kn + when compared with that before adding Kn + .n Conclusion:The mechanism of transient decrease in Kn + concentrations after 6% HES130/0.4 AHD may be related to the formation of “ ion bridge” between partial K n + and HSA-6% HES130/0.4 complex in the pediatric patients undergoing cardiac surgery.n