中华创伤杂志
中華創傷雜誌
중화창상잡지
Chinese Journal of Traumatology
2013年
3期
273-277
,共5页
欧珊%周乐顺%白树荣%巩固%林露%李军%潘显明
歐珊%週樂順%白樹榮%鞏固%林露%李軍%潘顯明
구산%주악순%백수영%공고%림로%리군%반현명
血液稀释%肾循环%术中血液回收
血液稀釋%腎循環%術中血液迴收
혈액희석%신순배%술중혈액회수
Hemodilution%Renal circulation%Intraoperative cell salvage
目的 评价万汶[体积分数6％羟乙基淀粉氯化钠溶液(HES)]用于急性高容血液稀释(acute hypervolemic hemodilution,AHH)加术中血液回收(intra-operative cell salvage,ICS)对骨科手术患者血流动力学、节血效能和肾功能的影响. 方法 选择58例骨科手术患者作为研究对象,按随机数字表法分为AHH+ ICS组(30例)和对照组(28例).比较AHH+ ICS组和对照组术前(TO)、手术结束时(T1)、术后4 h(T2)、术后1 d(T3)及术后2 d(T4)血流动力学指标心率(HR)、平均动脉压(MAP)、中心静脉压(CVP)的变化,肾功能指标血尿素氮(BUN)、血肌酐(BCr)、尿肌酐(UCr)和尿白蛋白(ALB)的变化,计算肌酐清除率(CCr)并观察术中血液保护情况.结果 两组间HR、MAP、CVP差异无统计学意义.两组T1 ～ T4时相点,HR与TO时相点比较有一定程度降低(P＜0.05),MAP及CVP与TO时相关比较均有上升(P＜0.05).两组BUN、BCr和ALB各时相点组间及组内比较,差异均无统计学意义.CCr分析结果显示:对照组各时相点差异无统计学意义；AHH+ICS组T1～T4时相点与TO时相点比较均有一定程度降低,T2时相点最低(P＜0.01),T3～T4时相点回升,T4时相点虽仍低于TO时相点但差异无统计学意义；AHH+ ICS组与对照组TO时相点比较差异无统计学意义,T1 ～ T4时相点,AHH+ ICS组均低于对照组,T2时相点最明显(P＜0.01),至T4时相点差异仍有统计学意义(P＜0.05).两组各时相点肾功能指标均在正常范围内.AHH+ ICS组及对照组术中失血量和尿量差异无统计学意义,术中补液量、异体血输注量及输注比例AHH+ ICS组明显少于对照组(P＜0.05或P＜0.01). 结论 采用万汶行AHH+ ICS用于骨科手术患者,能明显减少术中异体血输注量和输注比例,对基本生命体征和肾功能均无明显影响,是安全、有效、值得推广的综合血液保护措施.但在大剂量、长时间使用HES时仍应注意其可能的潜在肾功能损伤,对术前有严重肾功能障碍者应谨慎使用.
目的 評價萬汶[體積分數6％羥乙基澱粉氯化鈉溶液(HES)]用于急性高容血液稀釋(acute hypervolemic hemodilution,AHH)加術中血液迴收(intra-operative cell salvage,ICS)對骨科手術患者血流動力學、節血效能和腎功能的影響. 方法 選擇58例骨科手術患者作為研究對象,按隨機數字錶法分為AHH+ ICS組(30例)和對照組(28例).比較AHH+ ICS組和對照組術前(TO)、手術結束時(T1)、術後4 h(T2)、術後1 d(T3)及術後2 d(T4)血流動力學指標心率(HR)、平均動脈壓(MAP)、中心靜脈壓(CVP)的變化,腎功能指標血尿素氮(BUN)、血肌酐(BCr)、尿肌酐(UCr)和尿白蛋白(ALB)的變化,計算肌酐清除率(CCr)併觀察術中血液保護情況.結果 兩組間HR、MAP、CVP差異無統計學意義.兩組T1 ～ T4時相點,HR與TO時相點比較有一定程度降低(P＜0.05),MAP及CVP與TO時相關比較均有上升(P＜0.05).兩組BUN、BCr和ALB各時相點組間及組內比較,差異均無統計學意義.CCr分析結果顯示:對照組各時相點差異無統計學意義；AHH+ICS組T1～T4時相點與TO時相點比較均有一定程度降低,T2時相點最低(P＜0.01),T3～T4時相點迴升,T4時相點雖仍低于TO時相點但差異無統計學意義；AHH+ ICS組與對照組TO時相點比較差異無統計學意義,T1 ～ T4時相點,AHH+ ICS組均低于對照組,T2時相點最明顯(P＜0.01),至T4時相點差異仍有統計學意義(P＜0.05).兩組各時相點腎功能指標均在正常範圍內.AHH+ ICS組及對照組術中失血量和尿量差異無統計學意義,術中補液量、異體血輸註量及輸註比例AHH+ ICS組明顯少于對照組(P＜0.05或P＜0.01). 結論 採用萬汶行AHH+ ICS用于骨科手術患者,能明顯減少術中異體血輸註量和輸註比例,對基本生命體徵和腎功能均無明顯影響,是安全、有效、值得推廣的綜閤血液保護措施.但在大劑量、長時間使用HES時仍應註意其可能的潛在腎功能損傷,對術前有嚴重腎功能障礙者應謹慎使用.
목적 평개만문[체적분수6％간을기정분록화납용액(HES)]용우급성고용혈액희석(acute hypervolemic hemodilution,AHH)가술중혈액회수(intra-operative cell salvage,ICS)대골과수술환자혈류동역학、절혈효능화신공능적영향. 방법 선택58례골과수술환자작위연구대상,안수궤수자표법분위AHH+ ICS조(30례)화대조조(28례).비교AHH+ ICS조화대조조술전(TO)、수술결속시(T1)、술후4 h(T2)、술후1 d(T3)급술후2 d(T4)혈류동역학지표심솔(HR)、평균동맥압(MAP)、중심정맥압(CVP)적변화,신공능지표혈뇨소담(BUN)、혈기항(BCr)、뇨기항(UCr)화뇨백단백(ALB)적변화,계산기항청제솔(CCr)병관찰술중혈액보호정황.결과 량조간HR、MAP、CVP차이무통계학의의.량조T1 ～ T4시상점,HR여TO시상점비교유일정정도강저(P＜0.05),MAP급CVP여TO시상관비교균유상승(P＜0.05).량조BUN、BCr화ALB각시상점조간급조내비교,차이균무통계학의의.CCr분석결과현시:대조조각시상점차이무통계학의의；AHH+ICS조T1～T4시상점여TO시상점비교균유일정정도강저,T2시상점최저(P＜0.01),T3～T4시상점회승,T4시상점수잉저우TO시상점단차이무통계학의의；AHH+ ICS조여대조조TO시상점비교차이무통계학의의,T1 ～ T4시상점,AHH+ ICS조균저우대조조,T2시상점최명현(P＜0.01),지T4시상점차이잉유통계학의의(P＜0.05).량조각시상점신공능지표균재정상범위내.AHH+ ICS조급대조조술중실혈량화뇨량차이무통계학의의,술중보액량、이체혈수주량급수주비례AHH+ ICS조명현소우대조조(P＜0.05혹P＜0.01). 결론 채용만문행AHH+ ICS용우골과수술환자,능명현감소술중이체혈수주량화수주비례,대기본생명체정화신공능균무명현영향,시안전、유효、치득추엄적종합혈액보호조시.단재대제량、장시간사용HES시잉응주의기가능적잠재신공능손상,대술전유엄중신공능장애자응근신사용.
Objective To evaluate impacts of acute hypervolemic hemodilution (AHH) and intra-operative cell salvage (ICS) with 6％ volume fraction of hydroxyethyl starch (HES) on hemodynamics,blood saving efficiency and renal function of orthopedic surgery patients.Methods A total of 58 patients from orthopedic surgery were involved and randomly divided into AHH + ICS group (30 cases) and control group (28 cases).Changes of hemodynamic indices (HR,MAP and CVP) and renal function indices (BUN,BCr,UCr and ALB) in both groups were compared before operation (T0),immediately after operation (T1) and at postoperative 4 hours (T2),1 day (T3) and 2 days (T4).CCr was counted and intraoperative blood conservation was observed at each time point as well.Results HR,MAP and CVP of the two groups had no significant differences.Both groups showed some drop of HR (P ＜ 0.05),but an increase of MAP and CVP at T1-T4 (P ＜ 0.05),in contrast with levels at TO.BUN,BCr and ALB also showed insignificant differences between groups or within group at each time point.CCr in the control group showed no significant difference at each time point.On the contrary,CCr in the AHH + ICS group had a fall at T1-T4 and was declined to the lowest level at T2.CCr in the AHH + ICS group showed a recovery at T3-T4 and its level at T4 was still lower than that at TO,with no significant difference.CCr in the two groups showed insignificant difference at TO,but its level in the AHH + ICS group was lower than that in the control group at T1-T4,at T2 in particular (P ＜0.01).Moreover,CCr in the two groups was still significantly different at T4 (P ＜ 0.05).Renal function indices of the two groups were all within normal range at each time point.Intraoperative blood loss and unrine volume of the two groups had no significant differences,but intraoperative fluid requirement,allogenic blood transfusion volume and transfusion rate of AHH + ICS group were notably lower than those of control group (P ＜ 0.05 or P ＜0.01).Conclusions AHH plus ICS using HES are safe,effective and promising integrated blood conservation measures,which significantly reduces intraoperative allogenic blood transfusion volume and transfusion rate and has few impacts on fundamental vital signs and renal function.However,prolonged use of large dose of HES may do harm to renal function and therefore should be carefully considered in treatment of patients with severe renal dysfunction.
