改良急性非等容血液稀释联合控制性降压用于大失血手术的临床观察  

Clinicl effect of improved acute non-isovolemic hemodelution combined controlled hypotention in orthopedic surgery.

作　　者：曹蓉[1] 姜华[1] 

机构地区：[1]成都市第三人民医院,四川成都610031

出　　处：《四川医学》2005年第8期847-848,共2页Sichuan Medical Journal

摘　　要：目的观察改良的急性非等容血液稀释方法(iANIH)的血液稀释效果、节血作用及安全性,并与急性高容血液稀释比较。方法30例年龄18～60岁,ASAⅠ～Ⅱ级行肝脏、脊柱等估计失血量>1000ml手术病人,随机分为iANIH组(Ⅰ组),AHH组(Ⅱ组)。均采用全麻,诱导开始后快速补充15ml/kg贺斯加10ml/kg乳酸林格液。Ⅰ组患者诱导前按(所需扩容率-20%)×体重×70ml采血,采血时暂不扩容。采血后以等量贺斯补充血容量。手术结束前或Hct<23%时回输。两组在扩容时均以吸入异氟醚和硝酸甘油扩血管,并在手术开始后行控制性降压。监测病人MAP、HR、CVP及麻醉前、血液稀释后、术毕各时点Hct变化。结果两组血液稀释后CVP都明显增加,但均在安全范围;AHH组达轻度血液稀释,Hct31.9%;iANIH达到中度血液稀释,Hct27.4%。术后4hiANIH组Hct33.5%明显高于AHH组31.3%。结论iANIH联合控制性降压操作简便,能在容量负荷比较安全的范围内达到理想的稀释效果。较AHH稀释效率高,节血效果好。Objective To observe the effectency and safetiness of non-isovolemic hemodelution combined controlled hypotension,compared with acute hypervolemic hemodilution.nethods 30 ASA Ⅰ - Ⅱ patients of both sexes,aged between 18 - 60 yr,undergoing elective surgery which introoperative blood loss was expected more than 1000 ml.The patients were randomly divided into two groups： Ⅰ iANIH group （ n = 15 ） and Ⅱ AHH group （ n = 15 ）. 15ml/kg of 0.6 HES and 10ml/kg of lactated Ringer＇s solution were infusioned in 30 minutes when induction of a nesthesia was started in both groups. In group Ⅰ （ iANIH ） （ expected hemodilution rate - 20% ） × kg × 70ml of blood was removed through radial artery before induction anesthesia;Then BV was compensated with the same volume of HES infusion. The removed blood was reinfused at the end of surgery or when Hct 〈 23 %. Hypotension was accomplished by intravenous infusion of nitroglycerin. MAP, HR, CVP and Hct were monitored during operation. Results CVP of both group increased significantly after hemodilution,but all within safety range.ln group Ⅰ （iANIH） moderate hemodilution was achieved （Hct = 27.4% ＋ 2.9% ） while in group Ⅱ （AHH） only mild hemodilution was achieved （Hct = 31.9% ＋ 4.2% ） ;Hct was sigificantly higher in group Ⅰ （Hct = 33.5 % ＋ 5.2% ） than in group Ⅱ （31.3 ＋ 4.7 % ）. Blood loss was comparable between the two groups. Conclusion iANIH combined controlled hypotension is more effective than AHH, and can achieve satisfactory hemodilution while CVP within safety range.

关 键 词：急性非等容血液稀释 控制性低血压 CVP 

分 类 号：R614[医药卫生—麻醉学]