CAJ | 학술논문

目的探讨急性高容量血液稀释(AHH)联合氨甲环酸(TA)在神经外科手术中使用的安全性和有效性。方法将40例择期行神经外科手术患者，采用随机数字表法分为试验组和对照组，每组20例。两组全身麻醉后均输入6％羟乙基淀粉(130/0.4) 20 ml/kg做AHH，试验组将TA静脉注入负荷量10 mg/kg，以l mg/(kg·h)持续静脉输注直至手术结束；对照组仅做AHH。测定两组AHH前(T0)、AHH完成即刻(T1)、AHH后1 h(T2)、手术结束时(T3)的平均动脉压(MAP)、中心静脉压(CVP)、心率(HR)、脉搏血氧饱和度(SpO2)。并在对应各时点采静脉血测定血红蛋白(Hb)、红细胞压积(Hct)和凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、血小板计数(Plt)、纤维蛋白原(FIB)。统计两组术中出血量、输血量和输血率。结果两组患者HR、MAP组内各时点及组间比较差异无统计学意义(P＞0.05)，T1、T2时点CVP显著高于T0时点(P＜0.05)，T1、T2、T3时点Hb、Hct均显著低于T0时点(P＜0.05)。对照组T2、T3时点PT、APTT明显长于T0时点(P＜0.05)；两组T1、T2、T3 时点Plt均显著低于T0时点(P＜0.05)，对照组Plt在T2、T3时点较试验组降低更显著(P＜0.01)；对照组FIB在T2、T3时点显著低于T0时点(P＜0.05)。试验组术中出血量、输血量、输血率分别为(650±560) ml、( 150±50) ml、30％(6/20)，明显低于对照组的(820±410) ml、(380±290) ml、60％(12/20)，差异均有统计学意义(P＜0.05)。结论AHH联合TA静脉输注应用于神经外科手术，患者血流动力学稳定，对凝血功能影响小，有明显的节约用血效应。
목적탐토급성고용량혈액희석(AHH)연합안갑배산(TA)재신경외과수술중사용적안전성화유효성。방법장40례택기행신경외과수술환자，채용수궤수자표법분위시험조화대조조，매조20례。량조전신마취후균수입6％간을기정분(130/0.4) 20 ml/kg주AHH，시험조장TA정맥주입부하량10 mg/kg，이l mg/(kg·h)지속정맥수주직지수술결속；대조조부주AHH。측정량조AHH전(T0)、AHH완성즉각(T1)、AHH후1 h(T2)、수술결속시(T3)적평균동맥압(MAP)、중심정맥압(CVP)、심솔(HR)、맥박혈양포화도(SpO2)。병재대응각시점채정맥혈측정혈홍단백(Hb)、홍세포압적(Hct)화응혈매원시간(PT)、활화부분응혈활매시간(APTT)、혈소판계수(Plt)、섬유단백원(FIB)。통계량조술중출혈량、수혈량화수혈솔。결과량조환자HR、MAP조내각시점급조간비교차이무통계학의의(P＞0.05)，T1、T2시점CVP현저고우T0시점(P＜0.05)，T1、T2、T3시점Hb、Hct균현저저우T0시점(P＜0.05)。대조조T2、T3시점PT、APTT명현장우T0시점(P＜0.05)；량조T1、T2、T3 시점Plt균현저저우T0시점(P＜0.05)，대조조Plt재T2、T3시점교시험조강저경현저(P＜0.01)；대조조FIB재T2、T3시점현저저우T0시점(P＜0.05)。시험조술중출혈량、수혈량、수혈솔분별위(650±560) ml、( 150±50) ml、30％(6/20)，명현저우대조조적(820±410) ml、(380±290) ml、60％(12/20)，차이균유통계학의의(P＜0.05)。결론AHH연합TA정맥수주응용우신경외과수술，환자혈류동역학은정，대응혈공능영향소，유명현적절약용혈효응。
Objective To study the safety and effectiveness of acute hypervolemic hemodilution (AHH) combined with tranexamic acid (TA) in neurosurgical operation. Methods Forty patients underwent selective neurosurgical operation were divided into two groups by radom digits table with 20 cases each, both groups were infused HES(130/0.4) 20 ml/kg for AHH after anesthesia, TA intravenous injection of loading 10 mg/kg, 1 mg/(kg·h) continuous infusion until the end of surgery in experimental group,only for AHH in control group. The mean arterial blood pressure(MAP), central venous pressure(CVP), heart rate (HR), pulse oxygen saturation (SpO2) were measured before AHH (T0), A HH immediately (T1), 1 h after AHH (T2), at the end of operation (T3), and in the corresponding time hemoglobin (Hb), hematocrit (Hct),prothrombin time (PT), activated partial thromboplastin time (APTT), platelet ( Plt ), fibrinogen ( FIB ) were measured; the intraoperative bleeding, blood transfusion and transfusion rate were counted in both groups.Results There was no significant difference in HR and MAP at different time between two groups (P ＞0.05),compaued with T0,CVP at T1,T2 was increased (P＜0.05),Hb and Hct at T1,T2,T3 were decreased (P＜ 0.05 ). PT and APTT at T2,T3 were longer than that at T0 in control group (P＜ 0.05 ) ;Plt at T1 ,T2,T3 was lower in control group than that at T0 in two groups (P ＜ 0.05 ), Plt at T2, T3 was obviously increased in control group compared with experimental group (P ＜ 0.01 ) ; FIB at T2, T3 was lower than that at T0 in control group (P ＜0.05). The intraoperative bleeding, blood transfusion and transfusion rate in experimental group [(650 ±560) nl, (150 ± 50)ml,30％(6/20)]were lower than those in control group [(820 ±410) ml,(380 ±290) ml,60％ (12/20)],there were significant differences between two groups (P ＜0.05).Conclusion AHH combined with TA has obvious effect of saving blood and hemodynamic stability with less influence on coagulation in neurosurgical operation.