CAJ | 학술논문

目的：观察自体血液回收和控制性降压两种减少异体输血的方法及对脊柱外科手术患者脑组织氧合和乳酸代谢的影响，探讨两种方法联合应用的安全性及有效性。方法选择2011年12月至2013年5月我院ASA 分级Ⅰ～Ⅱ级脊柱外科手术患者60例，随机分成试验组（自体血回输联合控制性降压）和对照组，每组30例。两组患者均选择全身麻醉。于术前（T0）、术毕（T2）和术后24 h（T3）分别取右侧颈静脉球血和桡动脉血进行血气分析，记录动脉血氧分压（PaO2）、动脉血氧饱和度（SaO2）、颈静脉球血氧分压（PjvO2）、颈静脉球血氧饱和度（SjvO2）、动静脉血乳酸含量（LacA、Lacjv），并根据Fick公式分别计算脑动脉血氧含量（CaO2）、颈静脉球血氧含量（CjvO2）、脑氧耗[C（a-jv）O2]、脑氧摄取率（CERO2）及动静脉血乳酸含量差（ADVL）。T1为术中控制性降压稳定时的时点。记录两组患者的输液量、失血量、自体血回收量和异体血输入量及上述各时间点的血红蛋白值。结果两组患者年龄、体重、心率（HR）、术前血红蛋白水平（Hb）及术前凝血指标差异均无统计学意义（P＞0.05）；试验组异体血输注量明显少于对照组（P＜0.01）；试验组术毕（T2）、术后24 h（T3）Hb明显高于对照组（P＜0.01）。两组T0时CaO2、CjvO2、CERO2和ADVL差异均无统计学意义（P＞0.05）。与T0时相比，两组患者术毕（T2）及术后24 h（T3）时， CaO2、CjvO2显著下降（P＜0.05或P＜0.01）；相同时点比较，对照组T2、T3时CaO2、CjvO2下降快于试验组，差异有统计学意义（P＜0.01）。试验组T2、T3时与T0时相比，CERO2下降，差异有统计学意义（P＜0.01）；而对照组T2、T3时与T0时相比，CERO2上升，差异统计学意义（P＜0.01）。ADVL两组各时点差异均无统计学意义（P＞0.05）。试验组术中应用硝酸甘油控制性降压，术中血压（64.0±5.4）mmHg明显低于对照组（80.7±4.5）mmHg（P＜0.01）。结论脊柱外科手术中自体血回收联合控制性降压能明显减少异体血输注，且能改善脑组织氧合，对乳酸代谢无影响。目的：觀察自體血液迴收和控製性降壓兩種減少異體輸血的方法及對脊柱外科手術患者腦組織氧閤和乳痠代謝的影響，探討兩種方法聯閤應用的安全性及有效性。方法選擇2011年12月至2013年5月我院ASA 分級Ⅰ～Ⅱ級脊柱外科手術患者60例，隨機分成試驗組（自體血迴輸聯閤控製性降壓）和對照組，每組30例。兩組患者均選擇全身痳醉。于術前（T0）、術畢（T2）和術後24 h（T3）分彆取右側頸靜脈毬血和橈動脈血進行血氣分析，記錄動脈血氧分壓（PaO2）、動脈血氧飽和度（SaO2）、頸靜脈毬血氧分壓（PjvO2）、頸靜脈毬血氧飽和度（SjvO2）、動靜脈血乳痠含量（LacA、Lacjv），併根據Fick公式分彆計算腦動脈血氧含量（CaO2）、頸靜脈毬血氧含量（CjvO2）、腦氧耗[C（a-jv）O2]、腦氧攝取率（CERO2）及動靜脈血乳痠含量差（ADVL）。T1為術中控製性降壓穩定時的時點。記錄兩組患者的輸液量、失血量、自體血迴收量和異體血輸入量及上述各時間點的血紅蛋白值。結果兩組患者年齡、體重、心率（HR）、術前血紅蛋白水平（Hb）及術前凝血指標差異均無統計學意義（P＞0.05）；試驗組異體血輸註量明顯少于對照組（P＜0.01）；試驗組術畢（T2）、術後24 h（T3）Hb明顯高于對照組（P＜0.01）。兩組T0時CaO2、CjvO2、CERO2和ADVL差異均無統計學意義（P＞0.05）。與T0時相比，兩組患者術畢（T2）及術後24 h（T3）時， CaO2、CjvO2顯著下降（P＜0.05或P＜0.01）；相同時點比較，對照組T2、T3時CaO2、CjvO2下降快于試驗組，差異有統計學意義（P＜0.01）。試驗組T2、T3時與T0時相比，CERO2下降，差異有統計學意義（P＜0.01）；而對照組T2、T3時與T0時相比，CERO2上升，差異統計學意義（P＜0.01）。ADVL兩組各時點差異均無統計學意義（P＞0.05）。試驗組術中應用硝痠甘油控製性降壓，術中血壓（64.0±5.4）mmHg明顯低于對照組（80.7±4.5）mmHg（P＜0.01）。結論脊柱外科手術中自體血迴收聯閤控製性降壓能明顯減少異體血輸註，且能改善腦組織氧閤，對乳痠代謝無影響。
목적：관찰자체혈액회수화공제성강압량충감소이체수혈적방법급대척주외과수술환자뇌조직양합화유산대사적영향，탐토량충방법연합응용적안전성급유효성。방법선택2011년12월지2013년5월아원ASA 분급Ⅰ～Ⅱ급척주외과수술환자60례，수궤분성시험조（자체혈회수연합공제성강압）화대조조，매조30례。량조환자균선택전신마취。우술전（T0）、술필（T2）화술후24 h（T3）분별취우측경정맥구혈화뇨동맥혈진행혈기분석，기록동맥혈양분압（PaO2）、동맥혈양포화도（SaO2）、경정맥구혈양분압（PjvO2）、경정맥구혈양포화도（SjvO2）、동정맥혈유산함량（LacA、Lacjv），병근거Fick공식분별계산뇌동맥혈양함량（CaO2）、경정맥구혈양함량（CjvO2）、뇌양모[C（a-jv）O2]、뇌양섭취솔（CERO2）급동정맥혈유산함량차（ADVL）。T1위술중공제성강압은정시적시점。기록량조환자적수액량、실혈량、자체혈회수량화이체혈수입량급상술각시간점적혈홍단백치。결과량조환자년령、체중、심솔（HR）、술전혈홍단백수평（Hb）급술전응혈지표차이균무통계학의의（P＞0.05）；시험조이체혈수주량명현소우대조조（P＜0.01）；시험조술필（T2）、술후24 h（T3）Hb명현고우대조조（P＜0.01）。량조T0시CaO2、CjvO2、CERO2화ADVL차이균무통계학의의（P＞0.05）。여T0시상비，량조환자술필（T2）급술후24 h（T3）시， CaO2、CjvO2현저하강（P＜0.05혹P＜0.01）；상동시점비교，대조조T2、T3시CaO2、CjvO2하강쾌우시험조，차이유통계학의의（P＜0.01）。시험조T2、T3시여T0시상비，CERO2하강，차이유통계학의의（P＜0.01）；이대조조T2、T3시여T0시상비，CERO2상승，차이통계학의의（P＜0.01）。ADVL량조각시점차이균무통계학의의（P＞0.05）。시험조술중응용초산감유공제성강압，술중혈압（64.0±5.4）mmHg명현저우대조조（80.7±4.5）mmHg（P＜0.01）。결론척주외과수술중자체혈회수연합공제성강압능명현감소이체혈수주，차능개선뇌조직양합，대유산대사무영향。
Objective To observe the effects of blood salvage and controlled hypotension which can reduce allogeneic blood transfusion on brain tissue oxygenation and lactic acid metabolism in patients with spinal surgery, and to determine the efficacy and safety of combination. Methods Sixty patients scheduled for spinal surgery with ASA grade I-Ⅱ levels in our hospital from December 2011 to May 2013 were randomly divided into two groups with 30 cases in each:Experimental Group (blood salvage combing controlled hypotension) or Control Group. General anesthesia was chosen in all patients. Blood samples were taken from the right jugular bulb and radial arterial simultaneously before surgery (T0), the end of surgery(T2) and 24 hours after surgery (T3) for blood gas analysis. Arterial oxygen partial pressure (PaO2), arterial oxygen saturation degree (SaO2), jugular bulb blood oxygen partial pressure (PjvO2), jugular bulb oxygen saturation (SjvO2), arterial and venous blood lactic acid (LacA, Lacjv) were recorded. Cerebral arterial oxygen content (CaO2), jugular bulb oxygen content (CjvO2), cerebral oxygen consumption C (ajv) O2 , cerebral oxygen uptake rate (CERO2) and difference in arterial and venous lactic acid content (ADVL) were calculated according to Fick formula. T1 is the stable point of intraoperative controlled hypotension. Patients' infusion volume,blood loss,autologous blood transfusion,allogeneic blood transfusion and the hemoglobin levels were recorded at each time point of these two groups. Results There was no significant difference in age, body weight, heart rate (HR), preoperative hemoglobin level (Hb) and preoperative coagulation index between two groups(P>0.05). Allogeneic blood transfusion volumes were significantly less in Experimental Group than those in Control Croup (P<0.01). Hb at the end of surgery(T2) and 24 hours after surgery (T3) in Experimental Group were significantly higher than those in Control Group (P<0.01). Before surgery (T0), The CaO2, CjvO2, CERO2 and ADVL of the two groups had no statistical difference(P>0.05). The CaO2, CjvO2 decreased significantly at the end of surgery(T2) and 24 hours after surgery (T3)compared with T0 (P<0.05 or P<0.01) in two groups. The decrease of CaO2, CjvO2 was significantly more in Control Group than those in Experimental Group at T2, T3 point (P<0.01). CERO2 was significantly lower at T2, T3 point than at T0 in Experimental Group(P<0.01), while CERO2 was significantly higher in Control Group than at T0 in Experimental Group(P<0.01). ADVL had no significant differences at every point between these two groups (P>0.05). Blood pressure was significantly lower in Control Group[(64.0±5.4)mmHg] than those in Experimental Group[(80.7±4.5)mmHg] during operation by application of nitroglycerin. Conclusion Combining autologous transfusion with controlled hypotension during spinal surgery can significantly reduce allogeneic blood transfusion and improve the brain tissue oxygenation, and have no influence on lactate metabolism.