CAJ | 학술논문

目的：观察控制性低中心静脉压对经椎间孔腰椎融合术（TLIF）中出血量的影响。方法将50例 ASAⅠ~Ⅱ级全身麻醉下行经椎间孔腰椎融合术的患者随机分为控制性低中心静脉压组（A 组）和对照组（B 组）。入室后，常规麻醉诱导及维持。A 组分为两个阶段：第一阶段（LCVP 期）为麻醉诱导后到螺丝钉固定完成时，液体输注速度严格控制在7 ml/ min左右，将 CVP 维持<5 cm H2 O（1 cm H2 O =0.098 kPa）。第二阶段（LCVP 后）为螺丝钉固定完成后，以林格氏液和羟乙基淀粉补充液体缺失，恢复正常血流动力学。B 组采用传统液体管理，按照累积损失量和生理需要量以1：1的比例输入晶体液和胶体液，维持 CVP >10 cm H2 O，保证诱导时血流动力学的稳定。记录手术时间，并计算术中及术后出血量。测定术前和术后24 h 肝功能、肾功能。结果两组各时点 MAP、HR 比较差异无统计学意义（P >0.05）。与 B 组比较，A组 CVP 值在行控制性低中心静脉压期间均明显降低，两组比较差异有统计学意义（P <0.05）。两组手术时间、术中出血量、术后出血量比较，A 组均明显减少，差异有统计学意义（P <0.05）。两组患者术前及术后 ALT、AST、BUN 及 Cr 变化比较差异无统计学意义（P >0.05）。结论控制性低中心静脉压可明显减少 TLIF 术的术中及术后出血量，缩短手术时间，且对患者肝肾功能无影响。
목적：관찰공제성저중심정맥압대경추간공요추융합술（TLIF）중출혈량적영향。방법장50례 ASAⅠ~Ⅱ급전신마취하행경추간공요추융합술적환자수궤분위공제성저중심정맥압조（A 조）화대조조（B 조）。입실후，상규마취유도급유지。A 조분위량개계단：제일계단（LCVP 기）위마취유도후도라사정고정완성시，액체수주속도엄격공제재7 ml/ min좌우，장 CVP 유지<5 cm H2 O（1 cm H2 O =0.098 kPa）。제이계단（LCVP 후）위라사정고정완성후，이림격씨액화간을기정분보충액체결실，회복정상혈류동역학。B 조채용전통액체관리，안조루적손실량화생리수요량이1：1적비례수입정체액화효체액，유지 CVP >10 cm H2 O，보증유도시혈류동역학적은정。기록수술시간，병계산술중급술후출혈량。측정술전화술후24 h 간공능、신공능。결과량조각시점 MAP、HR 비교차이무통계학의의（P >0.05）。여 B 조비교，A조 CVP 치재행공제성저중심정맥압기간균명현강저，량조비교차이유통계학의의（P <0.05）。량조수술시간、술중출혈량、술후출혈량비교，A 조균명현감소，차이유통계학의의（P <0.05）。량조환자술전급술후 ALT、AST、BUN 급 Cr 변화비교차이무통계학의의（P >0.05）。결론공제성저중심정맥압가명현감소 TLIF 술적술중급술후출혈량，축단수술시간，차대환자간신공능무영향。
Objective To observe the effect of controlled low central venous pressure on the amount of bleeding during trans-foraminal lumbar interbody fusion. Methods Fifty patients with ASA Ⅰ - Ⅱunderwent transforaminal lumbar interbody fusion under general anesthesia were randomly divided into controlled low central venous pressure(LCVP)group(group A)and control group(group B). After arriving the operating room,the conventional anesthesia induction was adopted and maintained. Patients in group A were divided into two phases:the first phase(LCVP period):from the induction of anesthesia to the screws fixed, with the liquid infusion rate strictly controlled at 7 ml/ min,and the CVP was maintained at < 5 cm H2 O. The second phase(af-ter LCVP):after screws fixed,fluids loss was supplemented with Ringer′s solution and hydroxyethyl starch to restore normal he-modynamics. Patients in group B adopted the traditional fluid management,according to the cumulative loss and physical require-ments,colloid liquid and crystal liquid was infused at the ratio of 1:1. CVP was maintained at > 10 cm H2 O,to ensure the sta-ble hemodynamics during induction. The operation time was recorded,and the amount of intraoperative bleeding and postopera-tive bleeding was calculated. The preoperative and 24 h postoperative liver function and kidney function were recorded. Results There were no significant differences in MAP or HR at each time point between the two groups(P > 0. 05). The CVP value was significantly lower during the period of controlled low central venous in group A than that in group B,the difference was significant(P < 0. 05). Compared with group B,the surgical time,intraoperative blood loss,postoperative blood loss were sig-nificantly reduced in group A,the differences were significant(P < 0. 05). There was no significant difference’in the changes of ALT,AST,BUN or Cr levels between the two groups(P > 0. 05). Conclusion Controlled LCVP can significantly reduce the intraoperative and postoperative bleeding of TLIF,shorten the surgical time,and has no side effects on liver and renal function.