立止血结合高容血液稀释与控制性降压用于肿瘤手术的临床研究  

Clinical research of reptilase combined with hypervolemic hemodilution and controlled hypotension used in tumor surgery

作　　者：王远胜[1] 黄文起[2] 刘湘杰[1] 王连叶[1] 黄漫[1] 

机构地区：[1]江门市中心医院麻醉科,529030 [2]中山大学附属一医院麻醉科

出　　处：《国际麻醉学与复苏杂志》2009年第1期11-14,共4页International Journal of Anesthesiology and Resuscitation

基　　金：江门市科技计划项目（2004-021）

摘　　要：目的探讨立止血（reptilase，R）结合高容血液稀释（acute hypervolemic hemodilution，AHH）与控制性降压（comtrolled hypotension，CH）用于肿瘤手术的安全性和临床效果。方法60例患者随机分为3组：R＋AHH＋CH组（A组）、B组、c组，每组各20例，A组，术前静注立止血2000u，麻醉后30min内输入6％羟乙基淀粉130／0．415mL／kg，联合尼莫地平CH；B组，单纯尼莫地平CH；C组，术前静注立止血2000U。三组分别于诱导后动静脉置管完成时（基础值，To）、手术开始即刻（AHH后，T1）、手术开始后60min（T：）和术毕即刻（B）测定血红蛋白（Hb）、红细胞压积（Hct）、血小板（PLT）、纤维蛋白原（FIB）、部分凝血活酶时间（APTT）及凝血酶原时间（PT）、血浆渗透压（Posm）和乳酸（LA）。监测心率（HR）、平均动脉压（MAP）、中心静脉压（CVP）、心电图（ECG）、脉搏血氧饱和度（SpO2），记录三组术中的出血量和输血量。结果A组Hb、Hct在术中降低，在T1时点与B组、C组比较差异有统计学意义（P＜0．05）；A组PLT在T1、T2时点降低，在T，时点与B组、C组比较差异有统计学意义（P＜0．05）；C组Am、PT术中降低（P＜0．05）；B组降压期间CVP、MAP降低，HR增快（P＜0．05）；A组降压期间HR平稳。A组术中失血量和输血量均明显少于B组和C组（P＜0．05或P＜0．01）。结论止血结合高容血液稀释与控制性降压用于肿瘤手术可明显减少术中出血，对凝血功能影响小，血流动力学稳定，不失为一种安全有效、宜于推广的节约用血方法。Objective To investigate the safety and efficacy of reptilase combined with hypervolemic hemodilution and controlled hypotension used in tumor surgery. Methods 60 ASA Ⅰ-Ⅱ selected patients of tumor surgery were randomly allocated to three groups, group A： reptilase 2 000 U introvenous push before operation, 60 g/L HES（ 15 ml/kg） infused after induction of anesthesia, and nimodipine was used to maintain mean arterial pressure（MAP） between 60 mm Hg-65 mm Hg; group B, nimodipine was used to maintain MAP between 60 mm Hg-65 mm Hg; group C, reptilase 2 000 U introvenous push before operation. HR, MAP, CVP, SpO2 and ECG were continuously monitored throughout operation. Arterial and central venous blood samples were taken for determination of Hb, Hct, PLT, FIB, APTT, PT, Posm and LA at T0 （ baseline）, T1 （ onset of operation） , T2 （ 1 hour after operation） , T3 （ completion of operation） respectively. The volume of blood loss and transfusion were recorded during operation in all patients. Results The value of Hb,Hct in group A was obviously lower than that in goup B and in group C at Tl and the difference reached statistical significance （ P 〈 0.05 ） ; PLT in group A was decreased at T1 and T2, and the value of PLT in group A was lower than that in goup B and in group C at T1 （P 〈 0.05 ）. APTY,PT in group C at T1 and T2 were shorter than at To （ P 〈 0.05 ） ; CVP and MAP in goup B were significantly decreased after controlled hypotension（P 〈 0. 05 ） ; however, HR in gnup B was significantly increased （ P 〈 0. 05 ）, and HR in goup A was relatively stable after controlled hypotension （ P 〉 0.05 ）. The volume of blood loss and blood transfusion in group A were significantly less than that in goup B and C （ P 〈 0.05 or P 〈 0.01 ）. Conchmion Reptilase combined with hypervolemic hemodilution and controlled hypotension used in tumor surgery could effectively decrease the volume of blood loss during operation with relatively stable hemodynamics and mild si

关 键 词：立止血 血液稀释 控制性降压 肿瘤 

分 类 号：R614[医药卫生—麻醉学]