张茂荷 牟朝霞 陈体仙

[摘要] 目的 研究高海拔地区高原高血红蛋白血症围术期血液稀释对生命体征的影响。 方法 方便选择2012年5月—2016年5月世居迪庆州香格里拉高海拔地区居民，拟行腹腔镜胆囊切除术患者105例，分为血红蛋白正常组（N组=35例），高血红蛋白80例，高血红蛋白者分为高血红蛋白血液稀释组（SH组=35例）、高血红蛋白血液未稀释组（NH组=35例），SH組于术前3 d采用放5%循环血量（8 mL/kg），同时补充复方氯化钠液20 mL/（kg·24 h）（晶体胶体=2∶1）。 结果 血液稀释前， SH组和NH组患者血红蛋白（Hb）、红细胞血球压积（HCT）、全血高切粘度（WBHSV）、全血低切粘度（WBLSV）明显高于N组（P<0.05）;血液稀释后，SH组患者血红蛋白（Hb）、红细胞血球压积（HCT）、全血高切粘度（WBHSV）、全血低切粘度（WBLSV）明显高于N组，但明显低于NH组（P<0.05）;术中和苏醒期，与N组比较，NH和SH组患者血压、心率明显升高，与NH组比较， SH组患者血压、心率则明显降低（P<0.05）;与N组（20.00%）相比，NH组患者苏醒期脱氧后SPO2<86%的发生率（85.71%）明显增高;与NH组比较，SH组患者苏醒期脱氧后SPO2<86%的发生率（48.57%）则明显下降（χ2=30.425， P<0.01）。3组患者术中吸纯氧（SPO2>95%）和心律失常事件发生率分别为100.00%、88.57%、100.00%，2.86%、11.43%、5.71%，组间差异无统计学意义（P>0.05）;NH组患者术后伤口恢复时间较长（F=20.000，P<0.01）。 结论 术前血液稀释能降低高原高血红蛋白血症，并可明显减少患者术中和术后的血流动力学波动，并能明显改善患者术后苏醒期的氧合及恢复。

[关键词] 围术期;血液稀释;高原高血红蛋白血症;生命体征

[中图分类号] R55          [文献标识码] A          [文章编号] 1674-0742（2019）11（a）-0057-04

Effect of Perioperative Hemodilution on Vital Signs of High Altitude Hemoglobinemia

ZHANG Mao-he1， MOU Zhao-xia2， CHEN Ti-xian3

1.Department of Anesthesiology， the First Affiliated Hospital of Dali University， Dali， Yunnan Province， 671000 China; 2. Dali University Library， Dali， Yunnan Province， 671003 China; 3.Department of Blood Transfusion， the First Affiliated Hospital of Dali University， Dali， Yunnan Province， 671000 China

[Abstract] Objective To study the effect of perioperative hemodilution on vital signs in high altitude hyperglycemia in high altitude areas. Methods From May 2012 to May 2016， 105 people were Conveniently selected into the study in the high-altitude area of Shangri-La， Diqing Prefecture of Yunnan Province. They were divided into 120 patients with laparoscopic cholecystectomy， which were divided into normal hemoglobin group （N group=35 cases） and hyperhemoglobin in 80 cases. Hyperhemoglobin was divided into high hemoglobin hemodilution group （SH group=35 cases）， high hemoglobin blood undiluted group （NH group =35 cases）， and SH group received 5% circulating blood volume （8 mL/kg three days before surgery）， supplemented with compound sodium chloride solution 20 mL/（kg·24 h） （crystal colloid = 2∶1）. Results Before hemodilution， hemoglobin （Hb）， erythrocyte hematocrit （HCT）， whole blood high-viscosity （WBHSV）， and whole blood low-cut viscosity （WBLSV） were significantly higher in the SH group and the NH group than in the N group （P<0.05）; after hemodilution， hemoglobin （Hb）， erythrocyte hematocrit （HCT）， whole blood high-viscosity （WBHSV）， and whole blood low-cut viscosity （WBLSV） were significantly higher in the SH group than in the N group， but significantly lower than In the NH group （P<0.05）; compared with the N group， the blood pressure and heart rate of the NH group and the SH group were significantly higher than those of the NH group. Compared with the NH group， the blood pressure and heart rate of the SH group were significantly lower （P<0.05）; Compared with N group （20.00%）， the incidence of SPO2<86% （85.71%） in the NH group was significantly higher after deoxygenation during the recovery period; compared with the NH group， the SH group had SPO2<86% after deoxygenation incidence during the recovery period （48.57%） decreased significantly （χ2=30.425， P<0.01）. The incidence of pure oxygen in the three groups of patients with intraoperative （SPO2>95%） and the incidence of arrhythmia events were 100.00%， 88.57%， 100.00%， 2.86%， 11.43%， and 5.71%， respectively. There was no statistically significant difference between the groups （P>0.05）; patients in the NH group had a longer recovery time after surgery （F=20.000， P<0.01）. Conclusion Preoperative blood dilution can reduce high altitude hemoglobinemia， and can significantly reduce the hemodynamic fluctuations during and after surgery， and can significantly improve the oxygenation and recovery of patients after surgery.

[Key words] Perioperative period; Hemodilution; High altitude hyperhemoglobinemia; Vital signs

血红蛋白（hemoglobin，HGB）是红细胞的运载蛋白，其主要作用是摄取肺部大量的氧，并向机体各部输送氧，血红蛋白对氧的结合、储存、运输、释放具有重要的生理作用。人在海拔3 000 m以上高原地区可发生低张性缺氧，在高海拔地区世居或长期居住高原的人，由于高原特殊的气候、地理和饮食结构，高原人体内红细胞增多，变形能力下降、血红蛋白代偿性增加、血液黏稠度增高、血流阻力增大、微循环障碍，造成血液呈高凝状态，血管内血液流动不畅导致患者缺氧性损伤，尤其脑、心肺、肝、肾等耗氧较多的脏器损伤严重，严重者心脑血管栓塞而猝死，并且发病率随海拔的升高而升高[1]。该文，于2012年5月—2016年5月选取世居迪庆州香格里拉（海拔3 300 m）105例患者为例展开研究，高海拔导致的高血红蛋白血症对全身多器官的明显影响，增加患者围手术期风险。因此……