中华麻醉学杂志
中華痳醉學雜誌
중화마취학잡지
CHINESE JOURNAL OF ANESTHESIOLOGY
2008年
8期
731-733
,共3页
周孟虎%包明胜%刘林%鲁清%方才
週孟虎%包明勝%劉林%魯清%方纔
주맹호%포명성%류림%로청%방재
血液稀释%笛焦%控制性%输血,自体%矫形外科学
血液稀釋%笛焦%控製性%輸血,自體%矯形外科學
혈액희석%적초%공제성%수혈,자체%교형외과학
Hemodilution%Hypotension,controlled%Blood transfusion,autologous%Orthopedics
目的 评价脊柱手术患者急性高容量血液稀释(AHH)联合控制性降压及自体血液回收的效应.方法 择期行脊柱手术患者30例,随机分为2组(n=15):控制性降压联合自体血液同收组(Ⅰ组)和AHH联合控制性降压及自体血液回收组(Ⅱ组),Ⅱ组手术前输注6%羟乙基淀粉130/0.4(10 mi/kg)和复方乳酸钠林格氏液10 ml/kg,速率为30 ml/min.2组均在手术开始后静脉输注尼卡地平行控制性降压,速率为1.0~6.0 μg·kg-1·min-1,在lO~15min使MAP降至65~70mm Hg,直至脊柱内固定安器安装完毕.2组术中均行自体血液回收,于脊柱内固定器安装完毕后回输.术中持续监测血液动力学参数,记录术中异体输血情况、尿最及术后引流量、异体输血量.不良反应的发生情况.结果 2组术中HR和CVP均保持稳定.与Ⅰ组比较,Ⅱ组术中异体输血免除率升高,异体输血量减少(P<O.01),术中回收血量差异无统计学意义(P>O.05),尿量增多(P<O.01),术后引流量、异体输血量差异无统计学意义(P>0.05).2组均末见心、脑、肾功能异常的发生.结论 脊柱手术患考AHH联合控制性降压及自体血液回收可减免异体输血.
目的 評價脊柱手術患者急性高容量血液稀釋(AHH)聯閤控製性降壓及自體血液迴收的效應.方法 擇期行脊柱手術患者30例,隨機分為2組(n=15):控製性降壓聯閤自體血液同收組(Ⅰ組)和AHH聯閤控製性降壓及自體血液迴收組(Ⅱ組),Ⅱ組手術前輸註6%羥乙基澱粉130/0.4(10 mi/kg)和複方乳痠鈉林格氏液10 ml/kg,速率為30 ml/min.2組均在手術開始後靜脈輸註尼卡地平行控製性降壓,速率為1.0~6.0 μg·kg-1·min-1,在lO~15min使MAP降至65~70mm Hg,直至脊柱內固定安器安裝完畢.2組術中均行自體血液迴收,于脊柱內固定器安裝完畢後迴輸.術中持續鑑測血液動力學參數,記錄術中異體輸血情況、尿最及術後引流量、異體輸血量.不良反應的髮生情況.結果 2組術中HR和CVP均保持穩定.與Ⅰ組比較,Ⅱ組術中異體輸血免除率升高,異體輸血量減少(P<O.01),術中迴收血量差異無統計學意義(P>O.05),尿量增多(P<O.01),術後引流量、異體輸血量差異無統計學意義(P>0.05).2組均末見心、腦、腎功能異常的髮生.結論 脊柱手術患攷AHH聯閤控製性降壓及自體血液迴收可減免異體輸血.
목적 평개척주수술환자급성고용량혈액희석(AHH)연합공제성강압급자체혈액회수적효응.방법 택기행척주수술환자30례,수궤분위2조(n=15):공제성강압연합자체혈액동수조(Ⅰ조)화AHH연합공제성강압급자체혈액회수조(Ⅱ조),Ⅱ조수술전수주6%간을기정분130/0.4(10 mi/kg)화복방유산납림격씨액10 ml/kg,속솔위30 ml/min.2조균재수술개시후정맥수주니잡지평행공제성강압,속솔위1.0~6.0 μg·kg-1·min-1,재lO~15min사MAP강지65~70mm Hg,직지척주내고정안기안장완필.2조술중균행자체혈액회수,우척주내고정기안장완필후회수.술중지속감측혈액동역학삼수,기록술중이체수혈정황、뇨최급술후인류량、이체수혈량.불량반응적발생정황.결과 2조술중HR화CVP균보지은정.여Ⅰ조비교,Ⅱ조술중이체수혈면제솔승고,이체수혈량감소(P<O.01),술중회수혈량차이무통계학의의(P>O.05),뇨량증다(P<O.01),술후인류량、이체수혈량차이무통계학의의(P>0.05).2조균말견심、뇌、신공능이상적발생.결론 척주수술환고AHH연합공제성강압급자체혈액회수가감면이체수혈.
Objective To evaluate the blood-saving effect of acute hypervolemic hemodilution (AHH) combined with controlled hypotension (CH) and blood salvage (BS) in patients undergoing spine surgery. Methods Thirty ASAⅠ orⅡ patients of both sexes aged 25-55 yr weighing 45-75 kg undergoing spine surgery were included in this study. Their Hb was ≥ 120 g/L, platelet count ≥ 100 x 10<'9>/L and Hct≥35%. The patients were premedicated with intramuscular phenobarbital O. 1 g and atropine 0.5 rag. Anesthesia was induced with midazolam 0.05 mg/kg, fentanyl 3.0-4.0 μtg/kg, etomidate 0.3 mg/kg and atracurium 0.6-0.7 mg/kg and maintained with infusion of propofol at 3-4 mg·kg-1·h-1 and remifentanil at O. 12-0.15 μg·kg-2·min-1 and intermittent iv boluses of atracurium. The patients were intubated and mechanically ventilated. The patients were randomly divided into 2 groups(n=15 each): groupⅠCH + BS and groupⅡ AHH + CH + BS. CH was induced by infusion of nicardipine at 1.0-6.0 μg·kg-1·min-1 after operation was started until internal fixation of the spine was completed. MAP was maintained at 65-70 mm Hg and the blood shed during operation was salvaged with cell saver in both groups. AHH was induced with 6% HES 130/0.4 10 ml/kg and lactated Ringer's solution I0 ml/kg infused at 30 ml/min before operation in group Ⅱ . 6% HES 130/0.4 and lactated Ringer's solution (1:2) were infused during operation based on CVP and urine output. If blood loss > 25% of blood volume and Hct < 25% after the salvaged blood was infused, concentrated RBC was infused. Hemodynamics, the amount of banked blood infused, urine output and adverse reactions were recorded. Results The two groups were comparable with respect to M/F sex ratio, age, body weight and height, preoperative Hb, Her, PLT count and operation time. HR and CVP were kept stable in both groups. The percentage of the patients without allogeneic blood transfusion was significantly increased, volume of banked blood infused was significantly decreased while urine output was increased in group Ⅱ as compared with group Ⅰ . There was no significant difference in postoperative blood loss and allogeneic blood transfusion between the two groups. There was no adverse effect in either group. Conclusion AHH combined with CH and BS can significantly reduce allogeneic blood transfusion during the operation on the spine.