术前急性高容量血液稀释用于重度烧伤休克的可行性研究  

Feasibility studies of preoperative acute hypervolemic hemodilution to severely burned patients with shock

作　　者：张娟[1] 李俊华[1] 郑永辉[1] 魏世珍[1] 黄绍农[1] 

机构地区：[1]深圳市第二人民医院麻醉科,深圳518035

出　　处：《华中医学杂志》2007年第2期82-83,共2页Central China Medical Journal

摘　　要：目的评价处于休克期的重度烧伤患者于术前施行急性高容量血液稀释(AHH)的有效性和安全性。方法32例伴有低血容量性休克、血液浓缩的重度烧伤患者在静脉全麻下进行早期切痂植皮手术。随机分为两组,在手术麻醉前,AHH组(15例)按15ml/kg、以50ml/min的速度静脉输入6%羟乙基淀粉(HES),对照组(17例)仅常规常速输入乳酸钠林格氏液。监测并记录AHH前、后和术毕的钠、钾、氯、红细胞压积、血红蛋白、血小板、凝血酶原时间、活化部分凝血酶原时间、中心静脉压、血压、心率、脉搏血氧饱和度的变化。记录术中出血量、输液量和异体血输入量。结果AHH组的血压在稀释后和术毕明显高于对照组(P<0.05);AHH组的中心静脉压在稀释后明显升高(P<0.01),但在正常范围;AHH组的红细胞压积在稀释后明显低于对照组(P<0.01),但仍在正常范围;两组术中输液量和出血量无显著性差异(P>0.05),但AHH组的异体血输入量明显少于对照组(P<0.05);各时段的凝血酶原时间和活化部分凝血酶原时间两组间相比无显著性差异(P>0.05)。结论术前AHH可安全地用于重度烧伤休克患者切痂植皮手术,并可有效地提高其对失血的耐受性。Objective The purpose of this study was to evaluate the feasibility of application of preoperative acute hypervolemie hemodilution（AHH） to the severely burned patients with shock. Methods Thirty-two severely burned patients with hypovolemie shock undergoing burn wound excision and skin grafting under general anesthesia were enrolled in this study. The patients were randomly divided into two groups： Before anesthesia and operation, 6% hydroxyethyl starch （HES, 200/0. 5） 15ml/kg were infused at a rate of 50ml/min in AHH group（15cases）, and only lactated Ringevs solution were administered in control group（17cases）. Na, K, C1, HCT, Hb. Plt, PT.APTT.CVP, Bp, HR and SpO2 were monitored and recorded. The volume of infusion,blood loss and blood transfusion were recorded during the operation. Results After AHH,the blood pressure values in AHH group was higher than that in control group（P〈0. 05） ;the CVP values in AHH group was significantly higher than that in control group （P〈0. 01） ;and the values of Hct in AHH group was significantly lower than that in control group （P〈0.01）, but in normal range. Blood transfusion volume reduced significantly in AHH group（P〈0. 05）. At any period, there were no significant differences between both groups in the values of PT and APTT（P〉0. 05）. Conclusion Preoperative AHH can safely be applied to the severely burned patients with shock, and effectively reduce the blood transfusion.

关 键 词：手术前 血液稀释 6%羟乙基淀粉 重度烧伤 休克 

分 类 号：R614[医药卫生—麻醉学]