急性等容血液稀释对外伤性颅内血肿患者的脑保护作用  

Protective effect of acute normovolemic hemodilution on the brain in patients with traumatic intracranial hematoma

作　　者：李清平[1] 吴红利[1] 王忠岳[1] 祝捷[1] 严敏[2] 

机构地区：[1]舟山市中医骨伤联合医院麻醉科,316000 [2]浙江大学医学院附属第二医院麻醉科

出　　处：《浙江医学》2013年第11期1020-1022,1051,共4页Zhejiang Medical Journal

基　　金：浙江省医药卫生科技计划(省市共建)项目(2010SSA014)

摘　　要：目的探讨急性等容血液稀释(ANH)对外伤性颅内血肿患者的脑保护作用。方法 56例外伤性颅内血肿患者按随机数字表法分为血液稀释组(H组)28例和对照组(C组)28例。H组于术前行ANH,目标红细胞压积(Hct)为30%。两组患者分别于术前(T_0)、手术开始后2h(T_1)抽取静脉血测定血液流变学指标、脑组织氧代谢指标、S-100B蛋白浓度。结果两组患者T_0时的全血黏度高切、全血黏度中切、全血黏度低切、血浆黏度、红细胞聚集指数、红细胞刚性指数的差异均无统计学意义(均P>0.05)。T_1时,H组上述各指标均明显低于C组,两组间的差异均有统计学意义(均P<0.05)。T_0时,两组患者乳酸(VLAC)、颈内静脉球血氧饱和度(SjvO_2)、动脉-颈内静脉球部血氧含量差(Da-jvO_2)的差异均无统计学意义(均P>0.05);T_1时,两组患者的SjvO_2均有所降低,且H组高于C组,两组间的差异有统计学意义(P<0.05);而VLAC、Da-jvO_2较T_0时均升高,且H组低于C组,两组间的差异有统计学意义(P<0.05)。T_0时,两组患者的血清S-100B蛋白浓度的差异无统计学意义(P>0.05);T_1时,两组患者的差异有统计学意义(P<0.05)。结论 ANH可以降低血液黏度,减少血清中S-100B蛋白浓度,改善脑外伤后脑组织氧代谢紊乱,具有一定的脑保护作用。Objective To investigate the protective effect of acute normovolemic hemodilution （ANH） on the brain in pa- tients with traumatic intracranial hematoma. Methods Fifty six patients with traumatic intracranial hematoma were randomly as- signed to receive ANH before operation （group H, n=28） or not to receive ANH （group C, n=28）. The target hematocrit was 30%. Before （To） and 2h after operation（T1）, venous blood samples were taken for measurement of hemorheology, S-100B protein and lactate concentration. Results There were no significant differences in hemorheology parameters at To between two groups; however, the parameters at T1 in group H were significantly decreased （P〈0.05）. There were no significant differences in SjvO2, VLAC and Da-jvO2 at To between two groups（P 〉0.05）; however, at T1, SjvO2 was decreased in both groups compared to TO and SjvO2 in group H was higher than that in group C（P 〉0.05）; and VLAC, Da-jvO2 at T1 were increased in both groups compared at To, both parameters in group H were lower than those in group C （P〈0.05）. There were no significant differences in S-100B pro- tein concentration at To between two groups（P 〉0.05）, however S-100B protein level in group H at T1 was lower than that in group C （P〈0.01）. Conclusion Acute normovolemic hemodilution can reduce blood viscosity and S-100B protein levels in the serum, improve tissue oxygen metabolism of the brain and exert the protective effect.

关 键 词：血液稀释 外伤性颅内血肿 脑保护 

分 类 号：R614[医药卫生—麻醉学]