急性等容血液稀释对颅脑肿瘤病人围术期组织氧合的影响  

Oxygenated effect of acute and equal volume of blood dilution during perioperative period on patients with craniocerebral tumor

作　　者：谭立清 黄中华 甘丽霞 叶凤青 莫井延 张庆敏 宁加娟 

机构地区：[1]广西区人民医院麻醉科

出　　处：《广西医学》1999年第5期838-841,共4页Guangxi Medical Journal

基　　金：广西自治区自然科学基金

摘　　要：目的：观察颅脑肿瘤病人围术期实施急性等容血液稀释后对颅脑手术病人可能产生的影响。方法：随机观察１２例ＡＳＡＩ－Ⅱ级择期颅脑肿瘤切除术患者。麻醉诱导：硫贲妥钠４～８ｍｇ／ｋｇ，万可松０．０８ｍｇ／ｋｇ、芬太尼４～６μｇ／ｋｇ，司可林２ｍｇ／ｋｇ，经口明视下气管插管，接麻醉机，控制呼吸，吸入氧浓度为１００％，经右颈内静脉置入Ｓｗａｎ－Ｇａｎｚ导管，热稀释法测定心排量。按８ｍｌ／ｋｇ体重经右桡动脉穿刺针放血，以同样速度经右肘静脉输入等量的海脉素。监测血液稀释前、后、术毕病人氧供、氧耗、动、静脉血乳酸浓度等指标的变化，数据以均数±标准差表示，用配对ｔ检验，当Ｐ＜０．０５时，认为有意义。结果：平均放血量（４３０±１２０）ｍｌ，病人于围术期中出血量约（８００±１５０）ｍｌ。血液稀释后病人的心脏指数增加了２３％，氧供、氧耗、氧摄取率无显著变化，术毕颈内静脉血乳酸浓度升高，围术期中病人鼻咽温度维持在３５℃左右。结论：急性等容轻度血液稀释（８ｍｌ／ｋｇ）对于颅脑肿瘤病人术前无明显贫血者安全有效，可以减少输入异体血，适度血液稀释及围术期中保持亚低温有利于脑功能的保护。Objective:To observe the oxygenated effect of acute and equal volume of blood dilution on patients with craniocerebral tumorMethods:Twelve Grade ASAI patients who were performed nonacute craniocerebral tumorectomy were observed randomlyThe inductions of anesthesia were Sodium Thiopenthal 4￣8mg/kgNorcuron 008mg/kgFentanyl 4￣6mg/kg,Scoline 2mg/kgThe patients were connected with anesthesia machine through visual endotracheal intubationThe patients inhaled pure oxygen and the patientsrespiration was controlledThen SwanGanz catheters were inserted through right jugular veinAnd CO(cardiac output) was checked by heat dilutionBlood was let at 8ml/kg by puncturing needles through right radial arteries and the same amount of haemaccel was injected at the same speedAfter that,the changes of oxygen supplyoxygen consumption and the concentration of lactic acid of artery and venous blood were monitored separately before and after the blood dilution and after the operationsThe data was presented by the meanSD,and tested by a pair of t,when P<005,it was considered valuableResults:The average blood letting was 430120ml;the average amount of hemorrhage during perioperations was about 800150mlAfter transfusing ones own blood,it didnt have to transfuse extra othersbloodThe patientsindexes of hearts increased by 23% after dilutionThere was no significant changes in the rates of oxygen supplyoxygen consumption and oxygen absorptionAfter operations,the patientsconcentration of lactic acid in jugular vein increasedThe nasopharyngeal temperature kept at about 35 during operationsConclusions:The acute and proper blood dilution(8ml/kg) was safe and effective on patients with craniocerebral tumor without evident anemia before operations;it could decrease the transfusion amount of others bloodFurthermore,the proper blood

关 键 词：颅脑肿瘤 围手术期 组织氧合 血液稀释 

分 类 号：R739.41[医药卫生—肿瘤]