控制性降压联合自体血回输在脊柱手术中的应用  

Applicacation of controlled hypotension combined with autogolous blood transfusion on patients undergoing spinal surgery

作　　者：徐忠厚[1] 李家宽[1] 郑立东[1] 李建军[1] 

机构地区：[1]安徽医科大学附属六安医院麻醉科,237005

出　　处：《国际麻醉学与复苏杂志》2015年第3期209-212,共4页International Journal of Anesthesiology and Resuscitation

摘　　要：目的探讨控制性降压联合自体血回输技术应用于复杂脊柱外科大手术的临床效果及安全性。方法将40例脊柱外科大手术的患者用抽签法随机分为两组（每组20例）：控制性降压联合自体血回输组（A组）和非自体血回输组（B组）。A组全麻诱导后，术中用硝酸甘油行控制性降压，维持平均动脉压（meanarterial pressure，MAP）（65±5）mmHg（1mmHg=0．133kPa），并用血液回输仪回收术野出血；B组未行自体血回输；两组术中血细胞比容（hematocfit，Hct）低于25％即输库血。两组术中连续监测心率（heartrate，HR）、MAP、心电图（electrocardiogram，ECG）和中心静脉压（central venous pressure，CVP）。记录两组患者术中出血量、异体输血量及输血相关并发症，术前和术后24h红细胞（redblood cell，RBC）、血红蛋白（hemoglobin，Hb）、Hct、血小板（platelet，PLT）及凝血酶原时间（prothrombintime，PT）、活化部分凝血酶原时间（activeatedpartialthromboplastingtime，APTT）和纤维蛋白原（fibfinogen，FG）。结果A组出血量（1120±510）ml与B组（1524±457）ml比较，差异有统计学意义（P〈0．05）；A组输异体血发生率（10％）显著少于B组（100％）（P〈0．01）；术后24h两组患者RBC、Hb、Hct、PLT、PT、APTT和FG与术前比较差异有统计学意义（P〈0．05），但都在正常范围内，两组间比较差异无统计学意义（P〉0．05）；两组均无肺水肿、心力衰竭及创面异常出血并发症。结论控制性降压复合术中自体血回输在复杂脊柱手术中的应用是安全可靠的，能明显减少出血量，减少甚至避免异体血输入。Objective To evaluate the clinic effects and safety of controlled hypotension combined with autogolous （allogeneic） blood transfusion on patients undergoing spinal surgery. Methods Forty spinal surgery patients were randomly divided into two groups with 20 patients each. The mean arterial pressure（MAP） of patients in group A were maintained in a range of （65±5） mmHg （1 mmHg=0.133 kPa） by nitroglycerin and autogolous blood transfusion. The patients in group B were completed operatin without autogolous blood transfusion. Blood transfusion volume, postoperative red blood cell （RBC）, hemoglobin （Hb）, hematocrit （ Hot ）, platelet （PLT）, prothrombintime （PT）, aetiveated partial thromboplasting time （AFFF）, thromin time （TIP） as well as transfusion-related complications were compared between two groups. Results The blood loss in group A was significantly lower compared with group B（P〈0.05 ）. The RBC, Hb, Hct and PLT in group A after the end of operation were lower compared with that before operation（P〈0.05）. The PT, APTT, fibrinogen （FG） were increased in group A compared with that before operation（P〈 0.05 ）. No lung edema,heart failure and unconventionality bleeding occur in two groups. Conclusions Controlled Hypotension are safety and can decrease blood loss in spinal surgery, Autogolous blood transfusion can reduce the capacity of blood transfusion.

关 键 词：控制性降压 自体血回输 脊柱手术 

分 类 号：R614[医药卫生—麻醉学]