CAJ | 학술논문

目的探讨立止血(reptilase,R)结合高容血液稀释(acute hypervolemie hemodilution,AHH)与控制性降压(con-trolled hypotension,CH)用于肿瘤手术的安全性和临床效果.方法印例患者随机分为3组:R+AHH+CH组(A组)、B组、C组,每组各20例,A组,术前静注立止血2 000 U,麻醉后30 min内输入6%羟乙基淀粉130/0.4 15 ml/kg,联合尼莫地平CH;B组,单纯尼莫地平CH;C组,术前静注立止血2 000 U.三组分别于诱导后动静脉置管完成时(基础值,T0)、手术开始即刻(AHH后,T1)、手术开始后60 min(T2)和术毕即刻(T3)测定血红蛋白(Hb)、红细胞压积(Hct)、血小板(PLT)、纤维蛋白原(FIB)、部分凝血活酶时间(APTT)及凝血酶原时间(PT)、血浆渗透压(Posm)和乳酸(LA).监测心率(HR)、平均动脉压(MAP)、中心静脉压(CVP)、心电图(ECG)、脉搏血氧饱和度(SpO2),记录三组术中的出血量和输血量.结果 A组Hb、Hct在术中降低,在T1时点与B组、C组比较差异有统计学意义(P<0.05);A组PLT在T1、T2时点降低,在T1时点与B组、C组比较差异有统计学意义(P<0.05);C组APTT、PT术中降低(P<0.05);B组降压期间CVP、MAP降低,HR增快(P<0.05);A组降压期间HR平稳.A组术中失血量和输血量均明显少于B组和C组(P<0.05或P<0.01).结论止血结合高容血液稀释与控制性降压用于肿瘤手术可明显减少术中出血,对凝血功能影响小,血流动力学稳定,不失为一种安全有效、宜于推广的节约用血方法.
목적 탐토립지혈(reptilase,R)결합고용혈액희석(acute hypervolemie hemodilution,AHH)여공제성강압(con-trolled hypotension,CH)용우종류수술적안전성화림상효과.방법 인례환자수궤분위3조:R+AHH+CH조(A조)、B조、C조,매조각20례,A조,술전정주립지혈2 000 U,마취후30 min내수입6%간을기정분130/0.4 15 ml/kg,연합니막지평CH;B조,단순니막지평CH;C조,술전정주립지혈2 000 U.삼조분별우유도후동정맥치관완성시(기출치,T0)、수술개시즉각(AHH후,T1)、수술개시후60 min(T2)화술필즉각(T3)측정혈홍단백(Hb)、홍세포압적(Hct)、혈소판(PLT)、섬유단백원(FIB)、부분응혈활매시간(APTT)급응혈매원시간(PT)、혈장삼투압(Posm)화유산(LA).감측심솔(HR)、평균동맥압(MAP)、중심정맥압(CVP)、심전도(ECG)、맥박혈양포화도(SpO2),기록삼조술중적출혈량화수혈량.결과 A조Hb、Hct재술중강저,재T1시점여B조、C조비교차이유통계학의의(P<0.05);A조PLT재T1、T2시점강저,재T1시점여B조、C조비교차이유통계학의의(P<0.05);C조APTT、PT술중강저(P<0.05);B조강압기간CVP、MAP강저,HR증쾌(P<0.05);A조강압기간HR평은.A조술중실혈량화수혈량균명현소우B조화C조(P<0.05혹P<0.01).결론 지혈결합고용혈액희석여공제성강압용우종류수술가명현감소술중출혈,대응혈공능영향소,혈류동역학은정,불실위일충안전유효、의우추엄적절약용혈방법.
Objective To investigate the safety and efficacy of reptilase combined with hypervolemic hemodilution and coutrolled hypotension used in tumor surgery. Methods 60 ASA Ⅰ - Ⅱ selected patients of tumor surgery were randomly allocated to three groups, group A: reptilase 2 000 U introvenous push before operation, 60 g/L HES(15 ml/kg) infused after induction of anesthesia, and nimodipine was used to maintain mean arterial pressure(MAP) between 60 mm Hg-65 mm Hg; group B, nimodipine was used to maintain MAP between 60 mm Hg-65 man Hg; group C, reptilase 2 000 U introvenous push before operation. HR, MAP, CVP, SpO2 and ECG were continuously monitored throughout operation. Arterial and central venous blood samples were taken for determination of Hb, Hct, PLT, FIB, APTT, PT, Posm and LA at T0 (baseline), T1 (onset of operation) , T2 (1 hour after operation) , T3 (completion of operation) respectively. The volume of blood loss and transfusion were recorded during operation in all patients. Results The value of Hb ,Hct in group A was obviously lower than that in goup B and in group C at T1 and the difference reached statistical significance(P < 0.05) ; PLT in group A was decreased at T1 and T2, and the value of PLT in group A was lower than that in goup B and in group C at T1 (P <0.05). APTT,PT in group C at T1 and T2 were shorter than at T0(P <0.05) ; CVP and MAP in goup B were significantly decreased after controlled hypotension(P <0.05) ; however,HR in goup B was significantly increased(P < 0. 05), and HR in goup A was relatively stable after controlled hypoteasion (P > 0. 05). The volume of blood loss and blood transfusion in group A were significantly less than that in goup B and C (P < 0.05 or P < 0.01). Conclusion Reptilase combined with hypervolemic hemodilution and controlled hypotensiou used in tumor surgery could effectively decrease the volume of blood loss during operation with relatively stable hemodynamics and mild side effects, and could be generalized in chnical use.