琥珀酰明胶高容量血液稀释结合控制性降压用于脊柱外科手术的观察  

A Study of the application of deliberated hypotension Combined With acute hypervolemic hemodilution during Spinal Surgery

作　　者：王剑鸣[1] 张安生[1] 曾宾[1] 陈遇源[1] 

机构地区：[1]湖南省郴州市第一人民医院麻醉科,湖南郴州423000

出　　处：《海南医学》2007年第10期18-19,共2页Hainan Medical Journal

摘　　要：目的评价术前急性高容量血液稀释(AHH)应用于脊柱外科手术中节约用血的安全性。方法50例ASAⅠ～Ⅱ级腰椎骨折开放复位内固定病人,随机均分为观察组(G组)和对照组(R组)。G组,常规输入复方乳酸钠的同时予切皮前输入4%琥珀酰明胶(15ml/kg);R组,仅常规输入复方乳酸钠。两组均采用异氟醚吸入麻醉。术中用硝普钠控制性降压,持续监测平均动脉压(MAP)、心率(HR)、中心静脉压(CVP),分别于稀释前、稀释后、术毕测血小板计数(Plt)、凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、乳酸(Lac);记录术中输液量、输血量,并计算出血量。结果G组与R组MAP和HR平稳;G组CVP和PT稀释后明显升高和延长,Plt明显减少(P<0.05),但在正常范围内;APTT、Lac浓度组间比较差异无显著意义(P>0.05);术毕两组输液量和出血量差异无显著意义(P>0.05);G组输血量明显低于对照组(P<0.05)。结论采用4%琥珀酰明胶行AHH能安全应用于脊柱外科手术,血液动力学维持稳定,可有效地提高机体对失血的耐受性,明显减少异体输血量。Objective To evaluate the safety of the application of deliberated hypotension combined with acute hypervolemic hemodilution during spinal surgery. Methods Fifty ASA Ⅰ-Ⅱ patients with corrective surgery of the spine were randomized to two groups. The same account of lactated Ringer＇s solution was in- fused and isoflurane inhaled during operation in the patients of two groups. In AHH group, 4% Gelafusine （15ml/kg） was infused befare incision. MAP, HR, CVP, Hct were monitored. Plt, PT, APPF and Lac were measured before and after hemodilution, at the end of operation. The volume of infusion, blood loss and blood transfusion were recorded. Results Following hemodilution in AHH group, CVP and PF changed markedly （P〈 0.05）, but were still in the normal range. The required volume of Lactaced Ringer＇s solation and blood loss of two groups was similar. But blood transfusion was significantly less in AHH group than that in the contral （P〈 0.05）. Conclusions 4% Gelafusine can he used safely for AHH, and effectsively reduce the blood transfusion.

关 键 词：琥珀酰明胶 血液稀释 控制性降压 脊柱外科手术 

分 类 号：R614[医药卫生—麻醉学]