急性高容量血液稀释联合控制性降压在胸椎手术中的应用  

Acute Hypervolemic Hemodilution Combined With Controlled Hypotension in the Thoracic Vertebra Surgery

作　　者：旷昕[1] 李玉成[1] 李超[1] 彭庆明[1] 

机构地区：[1]南华大学第一附属医院麻醉科,湖南衡阳421001

出　　处：《南华大学学报（医学版）》2010年第4期509-511,共3页Journal of Nanhua University(Medical Edition)

摘　　要：目的观察术前急性高容量血液稀释联合术中控制性降压对血液的保护作用，评价其可行性。方法选择择期全麻俯卧位下行胸椎减压内固定手术患者60例，随机分成3组，术前急性高容量血液稀释联合术中控制性降压（实验组）、单纯控制性降压组和急性高容量血液稀释组，每组20例。手术开始前输血浆代用品菲克雪浓（明胶注射液）20mL／kg和复方林格氏液20mL/kg，速率50mL／min，术中采用微量泵输注硝普钠实施控制性降压，输注速率为0．5ug/kg·min，控制平均动脉压（MAP）在55—65mmHg。结果实验组实际失血量明显低于单纯控制性降压组和急性高容量血液稀释组。结论急性高容量血液稀释联合控制性降压，可减少术中出血量，提高节血效果和改善微循环，对机体的血液动力学、凝血功能、心功能及氧代谢均无明显影响。Objective To evaluate the effects and feasibility of acute hypervolumic hemodilution with controlled hypotention. Methods 60 patients scheduled for selective surgery were randomly divided into three groups with 20 eases in each group. Experimental group received hypervolemie hemodilution combined with controlled hypotension. One group received controlled hypotension, the other group received hypervolemic hemedilution. In experimental group and hypervolemie hemodilution group,20 mL/kg Ringer＇s solution and gelatin injection were infused by the rate of 50 mL/min. In operation hypotension of patients were controlled with nitroprusside sodium infused with mierepumb by the rate of 0.5 ug/kg . min. The mean arterial blood pressure was controlled （ MAP ） in 55 - 65 mmHg. Results The blood loss in experimental group was signifieangly less than the other groups. Conclusion The acute hypervolemic hemedilution combined with controlled hypotension, could reduce the volume of blood loss, increase effect and improve mieroeirculation of blood, moreover, there was no significant impact on the blood dynamics, blood coagulation, cardiac function and oxygen metabolism.

关 键 词：急性高容量 血液稀释 控制性降压 血液保护 

分 类 号：R619.1[医药卫生—外科学]