机构地区:[1]青岛大学附属医院麻醉科,山东省266003 [2]山东省文登整骨医院麻醉科
出 处:《中华临床医师杂志(电子版)》2014年第2期32-37,共6页Chinese Journal of Clinicians(Electronic Edition)
基 金:山东省科技发展计划(2011YD16037)
摘 要:目的:观察自体血液回收和控制性降压两种减少异体输血的方法及对脊柱外科手术患者脑组织氧合和乳酸代谢的影响,探讨两种方法联合应用的安全性及有效性。方法选择2011年12月至2013年5月我院ASA 分级Ⅰ~Ⅱ级脊柱外科手术患者60例,随机分成试验组(自体血回输联合控制性降压)和对照组,每组30例。两组患者均选择全身麻醉。于术前(T0)、术毕(T2)和术后24 h(T3)分别取右侧颈静脉球血和桡动脉血进行血气分析,记录动脉血氧分压(PaO2)、动脉血氧饱和度(SaO2)、颈静脉球血氧分压(PjvO2)、颈静脉球血氧饱和度(SjvO2)、动静脉血乳酸含量(LacA、Lacjv),并根据Fick公式分别计算脑动脉血氧含量(CaO2)、颈静脉球血氧含量(CjvO2)、脑氧耗[C(a-jv)O2]、脑氧摄取率(CERO2)及动静脉血乳酸含量差(ADVL)。T1为术中控制性降压稳定时的时点。记录两组患者的输液量、失血量、自体血回收量和异体血输入量及上述各时间点的血红蛋白值。结果两组患者年龄、体重、心率(HR)、术前血红蛋白水平(Hb)及术前凝血指标差异均无统计学意义(P>0.05);试验组异体血输注量明显少于对照组(P<0.01);试验组术毕(T2)、术后24 h(T3)Hb明显高于对照组(P<0.01)。两组T0时CaO2、CjvO2、CERO2和ADVL差异均无统计学意义(P>0.05)。与T0时相比,两组患者术毕(T2)及术后24 h(T3)时, CaO2、CjvO2显著下降(P<0.05或P<0.01);相同时点比较,对照组T2、T3时CaO2、CjvO2下降快于试验组,差异有统计学意义(P<0.01)。试验组T2、T3时与T0时相比,CERO2下降,差异有统计学意义(P<0.01);而对照组T2、T3时与T0时相比,CERO2上升,差异统计学意义(P<0.01)。ADVL两组各时点差异均无统计学意义(P>0.05)。试验组术中应用硝酸甘油控制性降压,术�Objective To observe the effects of blood salvage and controlled hypotension which can reduce allogeneic blood transfusion on brain tissue oxygenation and lactic acid metabolism in patients with spinal surgery, and to determine the efficacy and safety of combination. Methods Sixty patients scheduled for spinal surgery with ASA grade I-Ⅱ levels in our hospital from December 2011 to May 2013 were randomly divided into two groups with 30 cases in each:Experimental Group (blood salvage combing controlled hypotension) or Control Group. General anesthesia was chosen in all patients. Blood samples were taken from the right jugular bulb and radial arterial simultaneously before surgery (T0), the end of surgery(T2) and 24 hours after surgery (T3) for blood gas analysis. Arterial oxygen partial pressure (PaO2), arterial oxygen saturation degree (SaO2), jugular bulb blood oxygen partial pressure (PjvO2), jugular bulb oxygen saturation (SjvO2), arterial and venous blood lactic acid (LacA, Lacjv) were recorded. Cerebral arterial oxygen content (CaO2), jugular bulb oxygen content (CjvO2), cerebral oxygen consumption C (ajv) O2 , cerebral oxygen uptake rate (CERO2) and difference in arterial and venous lactic acid content (ADVL) were calculated according to Fick formula. T1 is the stable point of intraoperative controlled hypotension. Patients' infusion volume,blood loss,autologous blood transfusion,allogeneic blood transfusion and the hemoglobin levels were recorded at each time point of these two groups. Results There was no significant difference in age, body weight, heart rate (HR), preoperative hemoglobin level (Hb) and preoperative coagulation index between two groups(P>0.05). Allogeneic blood transfusion volumes were significantly less in Experimental Group than those in Control Croup (P<0.01). Hb at the end of surgery(T2) and 24 hours after surgery (T3) in Experimental Group were significantly higher than those
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