控制性降压联用巴曲亭对脊柱手术围术期出血量与凝血功能的影响  

Effects of controlled hypotension and combined use of hemocoagulase on perioperative hemorrhage and coagulation function in patients undergoing spinal surgery

作　　者：宗志军[1] 潘道波[2] 曾因明[1] 黄昌林[2] 吴雪峰[2] 

机构地区：[1]江苏省麻醉医学研究所,江苏徐州221002 [2]常德市第一人民医院麻醉科,湖南常德415003

出　　处：《徐州医学院学报》2008年第8期545-548,共4页Acta Academiae Medicinae Xuzhou

摘　　要：目的观察控制性降压联用巴曲亭对脊柱手术患者出血量与凝血功能的影响。方法骨科脊柱手术患者30例,随机分为联合组、巴曲亭组和降压组,每组10例。3组麻醉诱导和维持方法相同,联合组在手术开始前静脉输注巴曲亭2kU,切皮后在瑞芬太尼-丙泊酚静脉麻醉下以硝酸甘油行控制性降压;降压组只实施控制性降压而不给予巴曲亭;巴曲亭组在手术开始前静脉输注巴曲亭2kU而不实施控制性降压。实施控制性降压时平均动脉压波动于60～70mmHg(1mmHg=0.133kPa)。观察3组血流动力学、血栓弹力图(TEG)参数(K、R、ANG、MA)、出血量、输血量、术后24h引流量、输液量、尿量以及血红蛋白(Hb)和血小板计数(PLT)的改变。结果3组间年龄、体重、性别比例、手术时间、手术类别、输液量及尿量无差别,血流动力学稳定,其中降压组与联合组均成功控制性降压;联合组出血量较降压组和巴曲亭组明显减少,术后引流量联合组与巴曲亭组较降压组明显减少;围术期3组输血量和输血人数比例无差别,但联合组术后Hb水平较巴曲亭组和降压组高;3组间凝血功能参数无统计学差别。结论脊柱手术中控制性降压联用巴曲亭不仅能更有效减少术中出血量和术后引流量,而且对凝血功能无明显影响。Objective To investigate the effects of controlled hypotension with combined use of hemocoagulase on perioperative hemorrhage and coagulation function in patients undergoing spinal surgery. Methods Thirty patients un- dergoing spinal surgery were randomly divided into combination group, hypotension group and hemocoagulase group （ n = 10 each）, and they were under the same anesthesia. To the combination group, hemocoagulase iv was given before anesthesia induction, with infusion of nitroglycerin for controlled hypotension followed under remifentanil - diprivan intravenous anesthesia. The hypotension group and hemocoagulase group were only given nitroglycerin or hemocoagulase respectively. The controlled hypotension was targeted for MAP 60 -70 mmHg. The changes in MAP, HR, Hb, PLT and TEG parameters （K, R, MA, ANG）during surgery, as well as the amount of blood loss, blood transfusion, 24 h drainage after operation and urine output were all compared. Results The basic conditions of the patients were comparable among the three groups, their haemodynamics was kept stable, with the MAP well controlled in the combination group and hypotension group. The blood loss in combination group was less than in the other two groups. The amount of 24 h drainage after operation was less in the combination and hemocoagulase groups. There were no differences in blood transfusion between the three groups ,but the Hb level was higher in the combination group. The TEG parameters showed no significant differences. Conclusion Controlled hypotension and combined use of hemocoagulase in patients undergoing spinal surgery can reduce the perioperative hemorrhage and the amount of 24 h drainage after operation, yet has no adverse effects on patient＇s coagulation.

关 键 词：控制性降压 巴曲亭 脊柱手术 血液保护 出血量 凝血功能 

分 类 号：R614.27[医药卫生—麻醉学]