CAJ | 학술논문

目的探讨急性高容昔血液稀释(AHH)技术用于小儿脊柱侧弯后路融合术的临床效果与安全性.方法 36例择期行脊柱侧弯后路融合术的患儿随机分为AHH组(n=18)和对照组(CNT组,n=18).AHH组麻醉诱导后从颈内静脉输注万汶予以预扩容;CNT组常规补液,不进行额外扩容.术中当Hb<80 g/L或Hct<25%时输入同型异体红细胞,保持Het不低于25%.结果两组术中估计失血量差异无统计学意义.AHH组和CNT组术毕Hb[AHH组:(98±10)g/L;CNT组:(94±13)g/L]和术后第1天[AHH组:(89±12)g/L;CNT组:(92±22)g/L]都较术前下降(P<0.05),但两组问差异无统计学意义(P>0.05).AHH组术中输入同型异体红细胞(18±4)ml/kg,冷冻血浆(3.5±1.1)ml/kg,均少于CNT组[RBC:(28±11)ml/kg;FFP:(5.8±1.8)ml/kg],差异有统计学意义(P<0.05).结论急性高容量血液稀释技术在小儿脊柱侧弯后路融合术中具有很高的运用价值,可节约用血,减少医疗费用.
목적 탐토급성고용석혈액희석(AHH)기술용우소인척주측만후로융합술적림상효과여안전성.방법 36례택기행척주측만후로융합술적환인수궤분위AHH조(n=18)화대조조(CNT조,n=18).AHH조마취유도후종경내정맥수주만문여이예확용;CNT조상규보액,불진행액외확용.술중당Hb<80 g/L혹Hct<25%시수입동형이체홍세포,보지Het불저우25%.결과 량조술중고계실혈량차이무통계학의의.AHH조화CNT조술필Hb[AHH조:(98±10)g/L;CNT조:(94±13)g/L]화술후제1천[AHH조:(89±12)g/L;CNT조:(92±22)g/L]도교술전하강(P<0.05),단량조문차이무통계학의의(P>0.05).AHH조술중수입동형이체홍세포(18±4)ml/kg,냉동혈장(3.5±1.1)ml/kg,균소우CNT조[RBC:(28±11)ml/kg;FFP:(5.8±1.8)ml/kg],차이유통계학의의(P<0.05).결론 급성고용량혈액희석기술재소인척주측만후로융합술중구유흔고적운용개치,가절약용혈,감소의료비용.
Objective To evaluate the clinical efficacy and safety of acute hypervolemic hemodilution (AHH) in posterior spinal fusion surgery in children. Methods 36 children with scoliosis ASA Ⅰ～Ⅱ, receive of posterior spinal fusion, were randomly divided into 2 equal groups: AHH group,transfused with hydroxyethyl starch 130/0.4 and sodium chloride(Voluven) 12 ml/kg at the speed of 0.3 ～0.4 ml · kg-1. · min-1(for 30～40 min) through internal jugular vein before operation so as to keep the hemodilution (Hb) status during operation, and control (CNT) group. During operation when the Hb was <80 g/L or the hematocrit was < 25% blood transfusion was conducted to maintain the Hct > 25%.Results There was no significant difference in intra-operative blood loss between these 2 groups. The Hb one day after operation of the AHH group was (89 ± 12) g/L, significantly lower than that immediately after operation [(98 ± 10) g/L, P <0.05]. The Hb one day after operation of the CNT group was (92±22) g/L, significantly lower than that immediately after operation [(94 ± 13) g/L, P <0.05]. However, there were not significant differences in the Hb values between the AHH and CNT groups (all P > 0.05). Both groups received intra-operative transfusion during operation. The amount of transfused red blood cells and fresh frozen plasma of the AHH group were (18±4) ml/kg and (3.5±1.1) ml/kg respectively, both significantly lower than those of the CNT group [(28±11) and (5.8±1.8) ml/kg respectively, both P <0.05]. Conclusion Able to reduce intra-operative blood transfusion and medical expense, AHH can be used safely and effectively in posterior spine fusion in children.