术中大出血病人的麻醉处理与容量治疗的临床研究  

Clinical studies of anesthetic management and fluid therapy for patients with massive hemorrhage during surgery

作　　者：谭冠先[1] 刘敬臣[1] 倪玉霞[1] 胡振快[1] 李杰[1] 林成新[1] 

机构地区：[1]广西医科大学一附院麻醉科,南宁市530021

出　　处：《微创医学》2001年第6期768-770,共3页Journal of Minimally Invasive Medicine

基　　金：广西区卫生厅科技研究计划资助课题 (合同号 :桂卫 95 76 )

摘　　要：目的　探讨术中大出血病人的生理改变、麻醉估计与术中管理及以人造血浆代用品为主的容量治疗效果。方法　对术中出血量占全身血容量 40 %以上各种大手术病人 5 38例。采用气管内插管全麻 476例 ,硬膜外阻滞 6 2例 (术中大出血后改全麻 2 7例 ) ;术中监测血压、心电图、脉搏氧饱和度 (Sp O2 )、尿量 ,大部分病人监测中心静脉压 (CVP)、红细胞压积 (Hct)、血气分析。术中大出血时以血定安或羟乙基淀粉、乳酸钠林格氏液为主静脉输入 ,适量输红细胞或全血。结果　 5 38例病人出血量为 (2 5 5 2± 10 2 5 ) m l,出现低血压 6 1例 (11.3% ) ,休克 13例 (2 .4% ) ,CVP<4mm H2 O者 10 6例 (19.7% ) ,Sp O2 <92 %者 32例 (5 .9% )。出血量 30 0 0 m l以上的病人的 Hct、 PH、 HCO3、 BE、 K+均显著降低 (P <0 .0 5或 P <0 .0 1)。结论　对估计术中出血量大或以可能意外损伤大血管引起大出血病人最好选择气管内全身麻醉 ,加强监测。术中大量出血时 ,采取以输液输血为主的容量治疗可有效的恢复血容量。当大量出血无法控制或血源不足时 ,单纯输入液体不能凑效。Objective To investigate physiological changes, anesthetic management and effect of fluid therapy on restoring blood volume in patients with massive hemorrhage during surgery Methods We retrospectively studied 538 adult patients with blood loss more than 40% of total blood volume during surgery General anesthesia(476 cases)and epidural anesthesia (62 cases) were performed BP ECG、SPO2、CVP、HCT、Urinaryvolume and blood gas analyse were monitored When massive hemorrhage occurred, blood volume was maintained by mainly infusing Gelofusine or hydroxyethyl starch, sodium lactate Ringer's solution and properly transfusing packed red blood cells or whole blood Results Average blood loss was(2552±1025)ml Sixty one patients and thirteen patients presented hypotension and shock respectively A hundred and six patients presented with low CVP The values of HCT,PH,BE and serum potassium after massive hemorrhage were lower than before surgery (P<0 01 or P<0 05) in58 patients whose blood loss were beyond 3000ml Conclusions General anesthesia is most appropriate for the patients with tendency of massive hemorrhage duting surgery Fluid and transfusion therapy can restore blood volume effectively in most patients, bust can not in few patients due to incontrollable bleeding and insufficient blood supply

关 键 词：手术 大出血 麻醉 容量治疗 血浆代用品 

分 类 号：R614[医药卫生—麻醉学]