急性高容量血液稀释联合控制性降压在俯卧位脊柱手术中应用的临床分析
급성고용량혈액희석연합공제성강압재부와위척주수술중응용적림상분석
Clinical analysis of application of acute hypervolemic hemodilution with controlled hypotension in spinal operation at prone position
  • 万方数据
    中国医药导报 중국의약도보
    CHINA MEDICAL HERALD
    2014年 19期 51-55 ,共5页

    朱彩艳%王显春%钟飞焱%李季鸥%李俊华%罗南博

    주채염%왕현춘%종비염%리계구%리준화%라남박

    高容量血液稀释%控制性降压%脊柱手术%血液保护 高容量血液稀釋%控製性降壓%脊柱手術%血液保護
    고용량혈액희석%공제성강압%척주수술%혈액보호
    Acute hypervolemic hemodilution%Controlled hypotension%Spinal operation%Blood conservation
    目的：探讨急性高容量血液稀释(AHH)联合控制性降压(CH)在俯卧位脊柱手术中临床效果及安全性。方法选择2011年1月~2013年1月在深圳市第二人民医院骨科进行脊柱手术的72例患者,分为观察组和对照组,每组各36例。两组均采用静吸复合麻醉,观察组应用AHH联合CH；对照组常规补液。比较两组术中失血量、输血量、补液量及尿量；两组诱导前(T0)、AHH后(T1)、手术结束(T2)时的心率(HR)、平均动脉压(MAP)和中心静脉压(CVP)；两组T0、T1、T2和术后1 d(T3)时两组血红蛋白(Hb)含量和血细胞比容(HCT)；两组T0、T2时凝血功能相关指标；由手术医师对两组术“进行Fromme评分,并进行比较。结果淤观察组失血量、输血量少于对照组,输液量及尿量均多于对照组,差异均有高度统计学意义(P=0.0000)。于两组各时间点HR比较,差异无统计学意义(P跃0.05),T1时观察组MAP较T0时降低[(86.9±15.8)mm Hg(1 mm Hg =0.133 kPa)比(68.9±14.1)mm Hg],差异有高度统计学意义(t =5.1000,P=0.0000),且低于对照组T1时[(68.9±14.1)mm Hg比(85.6±14.4)mm Hg],差异有高度统计学意义(t =5.2773,P=0.0000)；T1、T2时观察组CVP值较T0时升高[(10.8±1.6)、(11.1±2.3)cm H2O比(7.5±1.3)cm H2O(1 cm H2O=0.098 kPa)],差异有高度统计学意义(t=9.6044、8.1757,P=0.0000),且高于对照组同时相[(10.8±1.6)cm H2O比(6.9±1.4)cm H2O,(11.1±2.3)cm H2O比(8.6±1.7)cm H2O],差异有高度统计学意义(t=11.0064、5.2446,P=0.0000)。盂观察组T1时Hb和HCT低于对照组[(99.8±13.9)g/L比(121.6±14.5)g/L,(27.1±3.9)豫比(38.7±4.1)豫],差异有高度统计学意义(t=6.6115、12.2998,P=0.0000),观察组T2时Hb低于对照组[(88.8±13.1)g/L比(108.3±14.6)g/L],差异有高度统计学意义(t =5.9647,P=0.0000),观察组T1、T2、T3时Hb低于T0时[(99.8±13.9)、(88.8±13.1)、(98.6±14.2)g/L比(124.6±10.8)g/L],差异有高度统计学意义(t =8.4533、12.6517、8.7442,P=0.0000),T1、T2时HCT低于T0时[(27.1±3.9)豫、(26.2±4.7)豫比(38.7±3.9)豫],差异有高度统计学意义(t=12.6191、12.2802,P=0.0000)。榆两组T0、T2时PT、APTT均在正常范围内,组间比较差异无统计学意义(P跃0.05)。虞观察组术“Fromme评分低于对照组[(2.1±0.5)分比(3.3±0.6)分],差异有高度统计学意义(t =9.2187,P=0.0000)。结论俯卧位脊柱手术应用AHH和CH可减少术中失血量,使术“更清晰,对血流动力学、组织血液供应及凝血功能影响小,是术中安全有效的血液保护方法。
    목적：탐토급성고용량혈액희석(AHH)연합공제성강압(CH)재부와위척주수술중림상효과급안전성。방법선택2011년1월~2013년1월재심수시제이인민의원골과진행척주수술적72례환자,분위관찰조화대조조,매조각36례。량조균채용정흡복합마취,관찰조응용AHH연합CH；대조조상규보액。비교량조술중실혈량、수혈량、보액량급뇨량；량조유도전(T0)、AHH후(T1)、수술결속(T2)시적심솔(HR)、평균동맥압(MAP)화중심정맥압(CVP)；량조T0、T1、T2화술후1 d(T3)시량조혈홍단백(Hb)함량화혈세포비용(HCT)；량조T0、T2시응혈공능상관지표；유수술의사대량조술“진행Fromme평분,병진행비교。결과어관찰조실혈량、수혈량소우대조조,수액량급뇨량균다우대조조,차이균유고도통계학의의(P=0.0000)。우량조각시간점HR비교,차이무통계학의의(P약0.05),T1시관찰조MAP교T0시강저[(86.9±15.8)mm Hg(1 mm Hg =0.133 kPa)비(68.9±14.1)mm Hg],차이유고도통계학의의(t =5.1000,P=0.0000),차저우대조조T1시[(68.9±14.1)mm Hg비(85.6±14.4)mm Hg],차이유고도통계학의의(t =5.2773,P=0.0000)；T1、T2시관찰조CVP치교T0시승고[(10.8±1.6)、(11.1±2.3)cm H2O비(7.5±1.3)cm H2O(1 cm H2O=0.098 kPa)],차이유고도통계학의의(t=9.6044、8.1757,P=0.0000),차고우대조조동시상[(10.8±1.6)cm H2O비(6.9±1.4)cm H2O,(11.1±2.3)cm H2O비(8.6±1.7)cm H2O],차이유고도통계학의의(t=11.0064、5.2446,P=0.0000)。우관찰조T1시Hb화HCT저우대조조[(99.8±13.9)g/L비(121.6±14.5)g/L,(27.1±3.9)예비(38.7±4.1)예],차이유고도통계학의의(t=6.6115、12.2998,P=0.0000),관찰조T2시Hb저우대조조[(88.8±13.1)g/L비(108.3±14.6)g/L],차이유고도통계학의의(t =5.9647,P=0.0000),관찰조T1、T2、T3시Hb저우T0시[(99.8±13.9)、(88.8±13.1)、(98.6±14.2)g/L비(124.6±10.8)g/L],차이유고도통계학의의(t =8.4533、12.6517、8.7442,P=0.0000),T1、T2시HCT저우T0시[(27.1±3.9)예、(26.2±4.7)예비(38.7±3.9)예],차이유고도통계학의의(t=12.6191、12.2802,P=0.0000)。유량조T0、T2시PT、APTT균재정상범위내,조간비교차이무통계학의의(P약0.05)。우관찰조술“Fromme평분저우대조조[(2.1±0.5)분비(3.3±0.6)분],차이유고도통계학의의(t =9.2187,P=0.0000)。결론부와위척주수술응용AHH화CH가감소술중실혈량,사술“경청석,대혈류동역학、조직혈액공응급응혈공능영향소,시술중안전유효적혈액보호방법。
    Objective To investigate the effectand safety of acute hypervolemic hemodilution (AHH) combined with controlled hypotension (CH) in spinal operation atprone position. Methods 72 patients with spine surgery atDepart-mentof Orthopedics in the Second People's Hospital of Shenzhen City, from January 2011 to January 2013, were as the research objects, and they were divided into observation group and control group, with 36 cases in each group. All the patients were treated with intravenous inhalation anesthesia, the patients in the observation group were treated with AHH combined with CH, while the control group was treated with conventional fluid infusion. The blood volume, blood transfusion, fluid intake and urine outputof the patients in two groups;before induction (T0), after AHH (T1), end of op-eration (T2) the heartrate (HR), mean arterial pressure (MAP) and central venous pressure (CVP) of the two groups, blood protein (Hb) contentand the hematocrit(HCT) of patients in two groups atT0, T1, T2 and 1 d after operation (T3); the related indexes of blood coagulation func-tion atT0, T2; the operation doctor underwentFromme scores of operation field on patients in two groups, and compared those between groups, above all the indexes werer observed and compared. Results [1]The blood loss, blood transfusion amountof patients in the observation group were less than those in the control group, the infusion and urine volume were more than those in the control group, the differences were statistically significant(P= 0.0000). [2]There was no statistical difference ateach time pointHR between the two groups (P>0.05); MAP of the observation group atT1 were decreased than thatatT0 [(86.9±15.8) mm Hg (1 mm Hg =0.133 kPa) vs (68.9±14.1) mm Hg], the difference was sta-tistically significant(t= 5.1000, P=0.0000), and itwas lower than thatof the control group atT1 [(68.9±14.1) mm Hg vs (85.6±14.4) mm Hg], the difference was statistically significant(t= 5.2773, P= 0.0000); CVP value of the observa-tion group atT1, T2 were higher than thatatT0 [(10.8±1.6), (11.1±2.3) cm H2O ( 1 cm H2O=0.098 kPa) vs (7.5±1.3) cm H2O], the differences were statistically significant(t=9.6044, 8.1757, P=0.0000), and they were higher than those of the control group [(10.8±1.6) cm H2O vs (6.9±1.4) cm H2O, (11.1±2.3) cm H2O vs (8.6±1.7) cm H2O], the differences were statistically significant(t=11.0064, 5.2446, P=0.0000).[3] Hb and HCT of the observation group atT1 were low-er than those of the control group [(99.8±13.9) g/L vs (121.6±14.5) g/L, (27.1±3.9)% vs (38.7±4.1)%], the differences were statistically significant(t=6.6115, 12.2998, P=0.0000);Hb of the observation group atT2 was lower than thatof the control group [(88.8±13.1) g/L vs (108.3±14.6) g/L], the difference was statistically significant(t= 5.9647, P=0.0000); Hb of the observation atT1, T2, T3 were lower than thatatT0 [(99.8±13.9), (88.8±13.1), (98.6±14.2) g/L vs (124.6±10.8)g/L], the difference was statistically significant(t= 8.4533, 12.6517, 8.7442, P= 0.0000); HCT atT1, T2 were lower than thatatTa [(27.1±3.9)%, (26.2±4.7)% vs (38.7±3.9)%], the differences were statistically significant(t=12.6191, 12.2802, P=0.0000). [4]PT, APTT of the two groups atT0, T2 were in the normal range, there was no statisti-cally significantdifference between the two groups (P>0.05).⑤Fromme scores of operation of the observation group was lower than thatof the control group [(2.1±0.5) scores vs (3.3±0.6) scores], the difference was statistically significant(t=9.2187, P= 0.0000). Conclusion AHH and CH in spinal operation atprone position can reduce the blood loss during the operation, and make the operation field more clear, ithas small influence on hemodynamics, blood supply function and coagulation, blood protection, itis safe and effective method in operation.
    원문보기 원문다운로드 사이트로이동
저자의 최근 논문