急性高容血液稀释在腰椎爆裂骨折手术中的应用  

CLINICAL STUDY OF ACUTE HTPERVOLEMIC HEMODILUTION FOR OPERATION ON LUMBAR VERTEBRAL FRACTURE

作　　者：陈小涛[1] 王述波[1] 董梅[1] 于建国[1] 

机构地区：[1]山东省文登整骨医院骨伤研究所,264400

出　　处：《中医正骨》2007年第9期8-9,共2页The Journal of Traditional Chinese Orthopedics and Traumatology

摘　　要：为探讨术前急性高容血液稀释(AHH)应用于腰椎爆裂骨折手术的可行性。选择择期行腰椎爆裂骨折手术患者54例,随机分为2组:术前急性高容血液稀释组(A组)和常规输液组(B组),每组27例。A组术前输入乳酸钠林格液8ml·kg-1补充术前禁食量和6%中分子羟乙基淀粉万汶TM(6%HES130/0.4)15ml·kg-1行急性高容血液稀释;B组术前只输入乳酸钠林格液8ml.kg-1,术中同A组。观察AHH前、后,术毕A组和B组心率(HR)、中心静脉压(CVP)、平均动脉压(MAP)、凝血功能、血常规、血氧饱和度(SPO2)、出血量及输血量。结果A组AHH后心率(HR)、脉搏氧饱和度(SPO2)稳定,部分凝血活酶时间(APTT)升高(P<0.01);CVP升高(P<0.01);血小板计数(PC)降低(P<0.01);血红蛋白(Hb)、血细胞比容(Hct)下降,但所有变化都在正常范围内。A组输血2例,B组输血9例,差异有极显著性(P<0.01)。表明术前急性高容血液稀释(AHH)不影响凝血功能,明显减少了异体血的输注,并且循环稳定,可安全应用于腰椎爆裂骨折手术病人。To study the feasibility of Acute Hypervolemic Hemodilution (AHH) in operation of Lumbar Vertebral Fracture (LVF).54 patients of LVF selected to operate were randomly divided into two groups: preoperative AHH (A) and common transfusion (B), 27 cases each group. Group A was treated by AHH of Sodium Lactate Ringer's Injection (SLRI) 8 ml·kg-1 and 6% middle molecule hydroxyethyl starch (6%HES 130/0.4) 15 ml·kg-1 before operation in order to supply the fasting, group B SLRI only, and the same in operation. Indicatrixes were observed before, afer AHH and after operation, such as heart rate (HR), central venous pressure (CVP), mean arterial pressure (MAP), blood clotting function, blood routine test, saturation of blood oxygen (SPO2), blood loss and blood transfusion amount. The results showed: HR and SPO2 were stable, a part of partial thromboplastin time increased (P<0.01), CVP increased (P<0.01), blood platelets count(PC) decreased (P<0.01), hemoglobin(HB) and hematocrit (HCT) decreased, and all changes were within normal limits. There was significant difference of blood transfusion between group A (2 cases) and group B (9 cases) (P<0.01). AHH before operration couldn’t affect blood clotting function, decreas transfusion of variant blood obviously, circulat stably, and be applied to operative patient of LVF.

关 键 词：胸腰椎爆裂骨折/治疗 血液稀释 血液动力学 羟乙基淀粉 临床研究 

分 类 号：R687.3[医药卫生—骨科学] R614[医药卫生—外科学]