急性高容量血液稀释联合七氟醚吸入用于脊柱手术患者的血液保护效果观察  

Blood conservation effects of acute hypervolemic hemodilution combined with sevoflurane inhalation in patients undergoing spinal surgery

作　　者：徐名开 刘勇军 李瑞龙 李世业 张成 陈捷 

机构地区：[1]贺州市人民医院麻醉科,广西贺州542800

出　　处：《海南医学》2014年第3期349-351,共3页Hainan Medical Journal

基　　金：贺州市科学研究与技术开发计划(编号:贺科能1212001)

摘　　要：目的探讨急性高容量血液稀释(AHH)联合七氟醚吸入对脊柱手术患者的血液保护效果。方法择期行脊柱手术的患者60例,性别不限,年龄34～67岁,体质指数18.5～27.8 kg/m2,ASA分级Ⅱ或Ⅲ级,随机分为对照组(C组)和急性高容量血液稀释联合七氟醚吸入组(A组),各30例。A组于麻醉诱导后行AHH(以25 ml/min)的速率输注6%羟乙基淀粉15 ml/kg),同时持续吸入1.0%～3.0%七氟醚行控制性降压。C组为空白对照组,不做任何处理。连续监测血流动力学指标(HR,MAP,CVP和SpO2),并于麻醉诱导前(T0,基础值)、切皮时(T1)、手术开始后60 min(T2)和术毕时(T3)采集动脉血样,测定凝血酶原时间(PT)、凝血活酶时间(APTT)和动脉血乳酸(Lac),记录术中出血量、异体输血量和尿量。结果与C组比较,A组T1～T2时点MAP明显下降(P<0.05),T1～T3时点CVP明显升高(P<0.05),各时点HR、SpO2、PT、APTT和Lac差异无统计学意义(P>0.05)。A组术中出血量、异体输血例数和输血量明显少于C组(P<0.05)。结论 AHH联合七氟醚吸入可减少术中出血量和异体输血量,且不影响凝血功能和微循环灌注,可安全用于脊柱手术的血液保护。Objective To study the blood conservation effects of acute hypervolemic hemodilution （AHH） combined with sevoflurane inhalation in patients undergoing spinal surgery. Methods Sixty ASA U or III patients of both sexes undergoing spinal surgery, aged 34-67 years old, with body mass index 18.5-27.8 kg/m2, were randomly di- vided into two groups （n=30）： control group （group C） and AHH combined with sevoflurane inhalation group （group A）. In group A, 6% hydroxyethyl starch solution 15 ml/kg was infused at a rate of 25 ml/min after induction of anes- thesia, and 1.5%-3.0% sevoflurane was inhaled to deliberate hypotension. In group C, the patients received no further processing. Haemodynamies parameters （HR, MAP, CVP and SpO2） were continuously monitored throughout the oper- ation. Arterial blood samples were collected for determination ofAPTT, PT and Lac before induction of anesthesia （To, baseline）, during incision （T1）, at 60 mins after incision （T~） and at the end of operation （T3）. The bleeding volume, transfusion of homologous blood and urine volume during the operation were recorded. Results MAP was significant- ly lower （P〈0.05） at Tt-T~, CVP was significantly higher at TI^T3 in group A than in group C （P〈0.05）. HR, SpOt, PT, APTT and Lac were no significantly different between the two groups at all time points （/9〉0.05）. Bleeding volume and transfusion of homologous blood were significantly lower in group A than in group C （P〈0.05）. Conclusion AHH combined with sevoflurane inhalation can decrease bleeding volume and transfusion of homologous blood, and has no adverse effect on coagulation function and microcirculation perfusion in patients undergoing spinal surgery. It is safe for perioperative blood conservation.

关 键 词：急性高容量血液稀释 七氟醚 血液保护 ACUTE hypervolemic HEMODILUTION (AHH) 

分 类 号：R687.3[医药卫生—骨科学]