Effect of low central venous pressure combined with acute hypervolemic hemodilution on pulmonary shunt and arterial oxygen pressure in patients with thoracic surgery
HU Zhengrong1 WEI Binhua1 LI Changke1 TAN Jiangbo2 WU Qinru3
1.Department of Anesthesiology, the Affiliated Yuebei People's Hospital, Shantou University Medical College, Guangdong Province, Shaoguan 512026, China; 2.Department of Emergency, Zhujiang Hospital, Souther Medical University, Guangdong Province, Guangzhou 510080, China;
3.Clinical Laboratory, the Affiliated Yuebei People's Hospital, Shantou University Medical College, Guangdong Province, Shaoguan 512026, China
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 From January 2015 to December 2017, ASA grade Ⅰ-Ⅱ undergoing elective radical resection of lung cancer and 50 thoracic surgery patients in the Affiliated Yuebei People's Hospital, Shantou University Medical College, were randomly divided into two groups: group AHHD with LCVP (group LA) and control group (group C), each group had 25 cases. Group LA was given the limited crystalloid the amount of nitroglycerin and continuousmicro pump injection method after anesthesia in advance of LCVP technology, control of CVP in 2-5 cmH2O, then combined with the application of AHHD technology, rapid infusion of 6% hydroxyethyl starch (130/0.4) 15 mL/kg on blood thinners, keep Hct at 25%-30%. Group C was maintained at the normal level of 6-12 cmH2O CVP. On the each time as 10 min after double lung ventilation in the supine position (T0), 10 min after one lung ventilation in supine position (T1), 10 min after single lung ventilation in lateral position (T2), 10 min after pulmonary lobectomy (T3), the blood glucose and cortisol level were measured by collecting, and the blood of the elbow. The radial artery blood and right atrial mixed venous blood was collected for blood gas analysis, and record blood glucose concentration, serum cortisol 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) etc.. The rate of intrapulmonary shunt (Qs/Qt), Qs/Qt = (CcO2-CaO2)/(CcO2-CvO2)×100% were calculated according to the standard three compartment model of pulmonary blood flow distribution. Results The blood glucose concentration, serum cortisol level, SpO2, HR, MAP, BIS, PetCO2 of patients in two groups at each time point was basically stable, but after one lung ventilation, LA group and group C significantly increased intrapulmonary shunt (P < 0.05), which increased by 13.7% and 14.9% respectively in supine position, lateral position increased 11.4% and 14.3% respectively. arterial oxygen partial pressure of two groups were significantly decreased (P < 0.05), and compared with the supine lateral position decreased more obviously, but there was no significant difference between the two groups (P > 0.05). After lobectomy, the intrapulmonary shunt in group LA and group C was significantly reduced (P < 0.05), 7.2% and 8.6% respectively, and the arterial oxygen partial pressure increased significantly in two groups (P < 0.05), but there was no 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 (χ2 = 4.902, P < 0.05). 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 of intraoperative blood transfusion.
胡峥嵘1 魏兵华1 李长科1 谭江波2 吴勤如3. 低中心静脉压联合急性高容量血液稀释对胸科手术患者肺内分流及动脉氧分压的影响[J]. 中国医药导报, 2018, 15(13): 80-84.
HU Zhengrong1 WEI Binhua1 LI Changke1 TAN Jiangbo2 WU Qinru3. Effect of low central venous pressure combined with acute hypervolemic hemodilution on pulmonary shunt and arterial oxygen pressure in patients with thoracic surgery. 中国医药导报, 2018, 15(13): 80-84.
2018, Vol. 15 
京公网安备 11010502046598号