血液回收、稀释和控制性降压术中联合应用的临床观察  

THE USE OF INTRAOPERATIVE BLOOD SALVAGE、HEMODILUTION COMBINED WITH CONTROLLED HYPOTENSION DURING ORTHOPAEDIC SURGERY

作　　者：王维强[1] 孙茜芬[1] 马性觉[1] 

机构地区：[1]成都市第三人民医院麻醉科,成都610031

出　　处：《现代预防医学》2007年第7期1368-1371,共4页Modern Preventive Medicine

摘　　要：[目的]研究术中血液回收、急性超容血液稀释和控制性降压三者合用于大出血骨科手术减少异体输血的安全性和有效性。[方法]选择ASAⅠ～Ⅱ级、预计出血量﹥800 ml的骨科手术(脊柱手术和髋关节手术)共40例,分两组。两组手术中均用自体血液回收机,Ⅰ组用七氟醚+硝酸苷油控制性降压联合应用20 ml/kg的6%羟乙基淀粉(HES)行急性超容血液稀释。观察术中两组病人血流动力学指标和Hb变化,出血和输血情况,围术期肝肾功能及凝血功能变化。[结果]Ⅰ组控制性降压期间MAP降低、CVP增加;Ⅰ组出血量和自体输血较Ⅱ组少,两组比较差异有统计学意义(P﹤0.01),Ⅰ组85%的病人不需输异体血,Ⅱ组为65%;两组病人围术期肝肾功能无明显变化;两组术毕血小板(Plt)与术前比较有降低(P﹤0.01),部分凝血酶原时间(APTT)有延长(P﹤0.05),未见明显出血倾向。[结论]术中血液回收同时运用急性超容血液稀释和控制性降压可以减少和避免大出血骨科手术异体输血和单纯运用血液回收比较更有优势,对肝肾功能及凝血功能的影响在临床可接受范围。[ Objective] To study the efficiency and salty of intraoperative blood salvage （IBS） , acute hypervolemic hemodilution （AHH） combined with controlled hypotension to reduce allogenice blood transfusion during orthopaedic surgery. [ Methods] 40 ASA Ⅰ-Ⅱ patients undergoing orthopaedic surgery were randomly divided into 2 groups （groupl and group Ⅱ） .All patients received intraoperative blood salvage. In group Ⅰ： controlled hypotension was accomplished by sevoflurane and nitroglycerin, maintain mean arterial pressure （MAP） at 55-65 mmHg, AHH was accomplished by 20 ml/kg of Hetastarch （6% HES） . The changes of hemodynamics, hemoglobin concentration （Hb） , blood loss, blood transfusion, blood coagulation, hepatic and renal functions were observed. [ Results] In group Ⅰ： MAP were significantly decreased during controlled hypotension; central venous pressure （CVP） were significantly increased, but they were all within the safety range. In group Ⅰ, the amount of blood loss and autotransfusion were significandy lower than that In group Ⅱ（P 〈 0.01） , In group Ⅰ, 85% of the patients （17/20） passed surgery successfully without allogenic blood transfusion, In group Ⅱ , 65% Venous blood sampies were taken before surgery, at the end of surgery and 24 h alter operation, there was no significant change in hepatic and renal functions. At the end of surgery, the amount of platelet of all patients remarkably lowered （P 〈 0.01 ） . Activated partial thromboplastin time （APTT） was prolonged （P 〈 0.05）, but within the safety range. [Conclusion] The use of intraoperative blood salvage, acute hypervolemic hemodilution combined with controlled hypotension is more effective than use intraoperative blood salvage during orthopaedic surgery only. The changes in blood coagulation、 hepatic and renal function are in the safety range.

关 键 词：血液回收 急性超容血液稀释 控制性降压 羟乙基淀粉 

分 类 号：R687.3[医药卫生—骨科学]