镇痛联合急性等容稀释对移植皮瓣影响的相关性研究  

Effects of hemodilution combined with preemptive analgesia on haemodynamics in free tissue graft

作　　者：丁明[1] 宗波[1] 付春兰[1] 王丙琼[1] 程庆钦[1] 

机构地区：[1]解放军89医院麻醉科,山东潍坊261021

出　　处：《山东大学学报（医学版）》2010年第2期153-156,共4页Journal of Shandong University:Health Sciences

摘　　要：目的探讨血液稀释联合超前镇痛对移植组织血流动力学影响。方法选择胫骨前软组织缺损采用股前外侧皮瓣修复患者160例,按照麻醉方法随即分为4组,A组:血液稀释联合超前镇痛,B组:血液稀释,C组:超前镇痛,D组:对照组。动态监测手术前后血小板计数、皮质醇、血清去甲肾上腺素含量、部分凝血酶时间、凝血酶原时间、并观察各组皮瓣血管危象发生及皮瓣成活率。结果术前各组指标差异无统计学意义;A组手术前后各指标间差异无统计学意义;B组术后皮质醇、APTT及PT显著增高;C组PLT、HCT显著增高,而皮质醇、血清去甲肾上腺素含量增高差异无统计学意义;D组变化同B组。血管危象发生率A<B<C<D组,皮瓣成活率A>C>B>D组。结论血液稀释联合超前镇痛可明显改善修复组织的血液循环,提高成活率。Objective To investigate the effects of hemodilution combined with preemptive analgesia on haemodynamics in free tissue graft. Methods 160 patients whose anticus tibialis soft tissue was lost and was repaired with a thigh anterolateral flap were randomly placed into 4 groups： the hemodilution combined with preemptive analgesia group （ group A）, the hemodilution group （ group B ）, the preemptive analgesia group （ group C） and the control group （ group D）. Pit, corticosteroid, serum norepinephrine, APTT and PT were detected perioperatively. The relationship between survival rate and blood vessel crisis of flap was observed. Results There was no significant difference in the above indexes among the 4 groups preoperatively. Corticosteroid, serum norepinephrine, APTT and PT were significantly increased after operation in group B and group D. PLT and PT were significantly increased after operation in group C. The incidence of blood vessel crisis was 2.5% in group A, 7.5% in group B, 2.5% in group C and 10% in group D. Survival rate of the flap was 100% in group A, 95 % in group B, 97.5 % in group C and 92.5 % in group D. Conclusion Hemodilution combined with preemptive analgesia can significantly improve the blood circulation and survival rate of the grafted tissue.

关 键 词：血液稀释 移植组织 血液循环 高凝状态 去甲肾上腺素 

分 类 号：R614.3[医药卫生—麻醉学]