高渗氯化钠羟乙基淀粉注射液用于急性高容量血液稀释联合控制性降压在脊柱手术中的应用  

The application of acute hypervolemic hemodilution with hypertonic sodium chloride hydroxyethyl injection combined with controlled hypotension in the spinal surgery

作　　者：陈慧[1] 朱昭琼[1] 阎薇[1] 王捷[1] 

机构地区：[1]遵义医学院附属医院麻醉科,贵州遵义563003

出　　处：《中国现代医学杂志》2011年第30期3806-3810,共5页China Journal of Modern Medicine

摘　　要：目的探讨高渗氯化钠羟乙基淀粉注射液(HSH)用于急性高容量血液稀释(AHH)联合控制性降压(CH)在脊柱手术中的安全性和有效性。方法 80例拟行脊柱手术的患者,随机均分为4组:CON组(不进行AHH与CH)、AHH组(用HSH进行输注)、CH组(用硝酸甘油进行降压)和AHH+CH组。术中持续监测平均动脉压(MAP)、心率(HR)及中心静脉压(CVP);分别于AHH前(T_0)、AHH后即刻(T_1)、手术开始后1h(T_2)、术毕(T_3)各时间点检测患者的血细胞比容(HCT)、乳酸(LAC)、碱剩余(BE)、氧分压(PO_2)、凝血酶原时间(PT)、活化部分凝血酶时间(APTT)、血Na^+,K^+,Cl^-的浓度、尿素氮(BUN)及肌酐(Cr),并记录术中输液量、输血量、出血量及尿量。结果①CH组与AHH+CH组在T_2时点MAP下降;CH组在T_2时点HR增快;AHH与AHH+CH组在T_1时点CVP增高(P<0.05)。②AHH组与AHH+CH组在T_1时点HCT下降、Na^+与Cl^-浓度以及PT与APTT增加(P<0.05);四组病人在各时点LAC、PO_2、SE、K^+、BUN和Cr的差异无统计学意义(P>0.05)。③四组患者术中输液量差异无统计学意义(P>0.05);CH组与AHH+CH组的出血量少于CON组及AHH组;AHH组与AHH+CH组的尿量多于CON组及CH组;AHH+CH组的输血量少于其它3组(P<0.05)。结论 HSH用于AHH联合CH可以减少术中出血量,提高节约用血效果和改善微循环。[ Objective ] To detect the safety and efficacy of the application of acute hypervolemie hemodilution （AHH） with hypertonie sodium chloride hydroxyethyl 40 injection （HSH injection） combined with controlled hypotension （CH） in the spinal surgery. [ Methods ] Eighty patients undergoing spinal surgery were randomly divided into four groups： group CON （no AHH and no CH）; Group AHH （AHH with HSH injection）; group CH （CH with nitroglycerin）; group AHH＋CH. Time points were defined as： before AHH （To）, at the end of AHH （T1）, 1 h after the beginning of operation （T2）, and at the end of operation （T3）. The MAP, HR and CVP were continuously monitored throughout the operation. Blood sample was obtained at T0, T1, T2 and T3 to measure HCT, LAC, BE, PO2, PT, APTF, the level of Na^＋, K^＋, and Cl^-, BUN and Cr. The volume of liquid and blood transfusion, hemorrhage and urine during operation were recorded. [ Results ] ①MAP were markedly lower at T2 than that at To in group CH and group AHH＋ CH; HR was apparently higher at T2 than that at To in group CH; CVP were significantly higher at T1 than that at TO in group AHH and group AHH＋CH （P 〈0.05）; ②HCT were obviously decreased at T1 in group AHH and group AHH＋CH; The Na^＋ and Cl^- contents in group AHH and group AHH＋CH at T1 were significantly higher than those at T0, but they were all within the normal limit. PT and APTT were obviously prolonged at T1 in group AHH and group AHH＋CH （P 〈0.05）; there was no significant difference in LAC, PO2, SE, K^＋, BUN and Cr at different time points in 4 groups （P 〉0.05）. ③The blood loss of group CH and group AHH＋CH were obviously less than that in group CON and group AHH; The urine volumes of group AHH and group AHH＋CH were significantly more than in group CON and group Ctt; The blood infusion of group AItH＋CH was notably less than that of any other group （P 〈 0.05）. [ Conclusion] Acute hypervolemic hemodilution with hypertonic sodium chloride h

关 键 词：高渗氯化钠羟乙基淀粉注射液 急性高容量血液稀释 控制性降压 血液保护 

分 类 号：R614[医药卫生—麻醉学]