急性高容量血液稀释联合控制性降压对脊柱手术患者全身炎性反应的影响  

Effects of acute hypervolemic hemodilution combined with controlled hypotension on systemic inflammatory response in patients with spinal surgery

作　　者：王继辉[1] 张庆[1] 

机构地区：[1]安徽医科大学附属合肥医院麻醉科,230011

出　　处：《临床麻醉学杂志》2015年第2期148-150,共3页Journal of Clinical Anesthesiology

基　　金：合肥市2010年度第一批科技计划项目(编号:合科〔2011〕25号)

摘　　要：目的研究急性高容量血液稀释（AHH）联合控制性降压（CH）对脊柱手术患者全身炎症反应的影响。方法择期脊柱手术患者60例,随机分为三组,每组20例。AHH组在麻醉诱导平稳后以30ml/min的速率输入6%羟乙基淀粉（130/0.4）15ml/kg,AHH＋CH组在行AHH的同时采用硝酸甘油进行CH,MAP控制在60~70mm Hg。对照组常规输入复方乳酸钠15ml/kg补充禁食禁饮、生理需要量及第三间隙损失量。分别在AHH前（T1）、AHH后（T2）、手术开始后2h（T3）、术毕（T4）、术毕24h（T5）采集外周静脉血测定血清降钙素原（PCT）、C-反应蛋白（CRP）、白细胞介素-6（IL-6）浓度。记录手术时间、术中失血量和输血量。结果与T1时比较,三组T3~T5时CRP、IL-6浓度明显升高（P〈0.05）。与对照组比较,AHH组和AHH＋CH组在T2~T5时CRP、IL-6浓度明显降低（P〈0.05）;T4、T5时,AHH组和AHH＋CH组PCT浓度均明显降低（P〈0.05）,AHH组和AHH＋CH组术中失血量、输血量明显减少（P〈0.05）。结论AHH或AHH联合CH不仅可减少脊柱手术患者术中失血量及输血量,而且可有效抑制围术期PCT、CRP、IL-6的表达,降低全身炎症反应。Objective To investigate the effects of acute hypervolemic hemodilution （AHH） combined with controlled hypotension（CH） on expression of serum procalcitonin, c-reactive protein, interleukin-6 in patients with spinal surgery. Methods Sixty patients undergoing elective spinal sur- gery were randomly divided into three groups （n=20） ： group AHH, group AHH＋CH and group control. Group AHH received AHH, and 6% HES （130/0.4） 15 ml/kg was infused at a rate of 30 ml/min after anesthesia induction. Group AHH＋CH received AHH and CH, the latter was induced with nitroglycerin to keep MAP between 60-70 mm Hg. The group control supplied preoperative tas- ting and water deprivation, physiological requirement and third-space fluid loss with sodium lactate kinger solution 15 ml/kg. The amount of intraoperative blood loss and blood transfusion of patients were recorded. The venous blood samples were taken at the beginning of AHH （T1）, after AHH （T2） ,2 hours after the surgery（Ta ）, at the end of the surgery（T4 ） and 1 day after surgery（T5 ） to measure the serum procalcitonin, c-reactive protein and interleukin-6. Results Compared to T1, the CRP and IL-6 were increased at T3-T2 in three groups（P〈0.05）. CRP and IL-6 were lower in groups AHH and AHH＋CH than those in group control （P〈0.05）. PCT in groups AHH and AHH＋CH at T4-T5was lower than those in group control （P〈0.05）. The blood loss and the amount of blood transfusion in group AHH and AHH＋CH were significant lower than those in group control （P〈 0.05）. Conclusion AHH or combined with CH can reduce blood loss and blood transfusion during spinal surgery, inhibit the expression of perioperative serum PCT, CRP, IL-6 and alleviate the sys- temic inflammatory response.

关 键 词：急性高容量血液稀释 控制性降压 全身炎症反应 

分 类 号：R614[医药卫生—麻醉学]