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目的:观察胶体液应用于急性等容血液稀释(ANH)对异位妊娠手术患者血流动力学的影响。方法:选择46例异位妊娠破裂伴出血性休克患者,随机分为晶体组和胶体组,每组23例。所有患者麻醉后、手术前经右颈内静脉采集自体血,放血速度控制在30ml/min左右,自体血储存于ACD-A保存液的储血袋内。晶体组从静脉输入等体积的乳酸钠林格氏液,胶体组输入等体积的6%羟乙基淀粉,血液稀释至HCT为32%。记录2组各时点血红蛋白(Hb)、血细胞比容(Hct)、血小板计数(PLT)、凝血酶原时间(PT)、活化凝血活酶时间(APTT)、平均动脉压(MAP)、心率(HR)、心脏指数(CI)、每搏量变异率(SVV)等指标以及术中出血量与输血量。结果:(1)与ANH前比较,ANH后2组Hb、Hct、PLT明显下降(P<0.05),PT、APTT明显延长(P<0.05)。(2)自体血回输前、回输后晶体组MAP低于ANH前(P<0.05),SVV高于ANH前(P<0.05),胶体组CI明显高于ANH前(P<0.05)。晶体组自体血回输前、回输后MAP及CI明显低于胶体组(P<0.05),SVV明显高于胶体组(P<0.05)。(3)2组出血量无明显差异,晶体组异体红细胞输注量明显多于胶体组(P<0.05)。结论:胶体溶液用于异位妊娠手术患者术前ANH,更有利于血流动力学的稳定,具有更明显的血液保护效应。
Objective: To observe the effect of colloidal fluid on hemodynamics in patients with ectopic pregnancy after acute isovolemic hemodilution (ANH). Methods: Forty-six patients with ectopic pregnancy with hemorrhagic shock were randomly divided into crystal group and colloid group, with 23 cases in each group. All patients after anesthesia, before surgery by the right internal jugular vein autologous blood collection, blood speed control at 30ml / min or so, autologous blood stored in the ACD-A preservation solution within the blood bag. An equal volume of sodium lactate Ringer’s solution was injected into the lens group, an equal volume of 6% hydroxyethyl starch was injected into the colloid group, and the blood was diluted to HCT 32%. The levels of Hb, Hct, PLT, PT, APTT, MAP and heart rate in each group were recorded HR), cardiac index (CI), stroke volume variation (SVV) and other indicators as well as intraoperative blood loss and blood transfusion. Results: (1) Hb, Hct and PLT decreased significantly in ANP group compared with those before ANH (P <0.05), PT and APTT prolonged significantly (P <0.05). (2) The MAP of crystalloid group was lower than that before ANH (P <0.05), before SVH was higher than that before ANH (P <0.05). The CI of colloid group was significantly higher than that before ANH (P <0.05). The levels of MAP and CI in the crystalloid group before and after reinfusion were significantly lower than those in the colloid group (P <0.05), and SVV was significantly higher than that in the colloid group (P <0.05). (3) There was no significant difference in the amount of hemorrhage between the two groups. The amount of allogeneic erythrocytes infused into the lens group was more than that of the colloid group (P <0.05). Conclusion: Colloidal solution for preoperative ANH in patients with ectopic pregnancy is more conducive to the stability of hemodynamics, with a more obvious blood protection.