急性高容量血液稀释联合控制性降压对脊柱手术围术期血液保护的研究  

Blood conservative effect of acute hypervolemic hemodilution combined with controlled hypotension in spinal surgery

作　　者：袁利邦[1] 景调平 贺雅琳[1] 刘晓华[1] 丁志刚[1] 黄伟[1] 梁华[1] 

机构地区：[1]解放军第五医院麻醉手术科,宁夏银川750004

出　　处：《西北国防医学杂志》2015年第1期4-7,共4页Medical Journal of National Defending Forces in Northwest China

基　　金：宁夏回族自治区科技攻关项目资助(20112YS274)

摘　　要：目的：观察术前急性高容量血液稀释联合术中控制性降压在脊柱手术中的血液保护作用,并与单纯使用这两种技术的血液保护进行比较,评价其安全性及优越性。方法：选择择期全麻下行胸腰椎减压内固定手术患者80例,随机分为对照组、单纯控制性降压组、单纯急性高容量血液稀释组和急性高容量血液稀释联合术中控制性降压组,每组20例。麻醉诱导后手术开始前,以10ml/min的速率予高渗氯化钠羟乙基淀粉40注射液（HSH溶液）4ml/kg经颈内静脉滴注行急性高容量血液稀释,术中采用微量泵输注硝酸甘油0.2~0.5μg/（kg·min）实施控制性降压,控制平均动脉压在（65±5）mmHg。结果：联合组实际失血量明显低于单纯控制性降压组和单纯急性高容量血液稀释组。结论：急性高容量血液稀释联合控制性降压,可减少术中出血量,提高节血效果和改善微循环,对机体的血液动力学、内环境均无明显影响,具有更优越的血液保护效果。Objective：To evaluate the blood conservative effect and feasibility of acute hypervolumic hemodilution（AHH）combined with controlled hypotension（CH）in spinal surgery.Methods：A total of 80 patients scheduled for elective spinal surgery under general anesthesia were randomly divided into the control group,simple CH group,simple AHH group,and AHH combined with CH group.After induction of anesthesia before surgery,4 ml/kg HSH injection were infused by the rate of 10 ml/min viainternal jugular vein for the AHH.For CH,the micro pump infusion of nitroglycerin 0.2-0.5μg/（kg·min）were implemented to control the mean arterial pressure（MAP）at（65±5）mmHg.Results：The blood loss in AHH combined with CH group was significantly less than those of other groups.Conclusion：The AHH combined with CH could reduce the volume of blood loss,increase blood conservation effect and improve microcirculation of blood.Moreover,there is no significant impact on the blood dynamics.

关 键 词：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]