控制性低中心静脉压对脊柱手术患者血管外肺水和失血量的影响  

Effect of controlled low central venous pressure on extravascular lung water and bleeding volume of patients during spine surgery

作　　者：张俊杰[1] 刘心瑶[2] 张成梁[1] 鄢建勤[1] 杨华[3] 

机构地区：[1]中南大学湘雅医院麻醉科,长沙市410008 [2]中南大学湘雅三医院心内科 [3]湖南省肿瘤医院胸内一科

出　　处：《临床麻醉学杂志》2015年第5期427-431,共5页Journal of Clinical Anesthesiology

基　　金：2013年贝朗麻醉科学研究基金(BBF-2013-010);中南大学湘雅医院临床科研基金(2013L013)

摘　　要：目的观察术中行控制性低中心静脉压（controlled low central venous pressure,CLCVP）对脊柱手术患者血管外肺水（extravascular lung water,EVLW）和失血量的影响。方法 36例择期行腰椎后路椎管减压植骨融合术的患者随机分为CLCVP组（L组）和对照组（C组）,每组18例。L组于手术开始后通过限制输液联合静脉输注硝酸甘油使CVP维持在2～4cm H2O,植骨融合完成后迅速扩容使CVP恢复正常。C组常规补液,维持CVP在6～12cm H2O。分别于麻醉诱导后仰卧位（T0）、降压前俯卧位（T1）、CLCVP后30min（T2）、60min（T3）、90min（T4）和手术结束时（T5）记录血流动力学和EVLWI的变化;记录术毕总失血量和总输血量,单独记录CLCVP期间失血量与CVP和MAP相关性。结果与T0时比较,T1时两组CVP、T2时L组SVRI明显升高（P〈0.05）。与T1时比较,T4时两组HR明显增快、CI明显升高（P〈0.05）,T2～T4时L组MAP、CVP、ITBVI和T4时C组MAP、CVP明显降低（P〈0.05）。与C组比较,L组T2～T4时MAP、CVP,T3、T4时SI明显降低（P〈0.05）,而SVRI明显升高（P〈0.05）,术中L组总失血量、总输血量和总输液量、尿量均明显减少（P〈0.05）。结论脊柱外科手术中应用CLCVP在减少术中失血量和输血量的同时,对患者的血流动力学和EVLW无不良影响。Objective To investigate the effect of controlled low central venous pressure（CLCVP）on hemodynamics,extravascular lung water（EVLW）and bleeding volume of patients during spine surgery.Methods Thirty-six patients scheduled for spine surgery were randomly divided into group L（n=18）and group C（n=18）.The CVP of group L was maintained at 2-4cm H2 O by restricting fluid infusion and nitroglycerin injection after the onset of the surgery,and was returned to normal after hemostasis by volume expanding.While the group C was treated routinely and normal CVP（6-12 cm H2O）was maintained.Hemodynamic parameters and EVLWI were recorded after induction of anesthesia（T0,supine position）,before CLCVP（T1,prone position）,30 min after CLCVP（T2）,60 min after CLCVP（T3）,90 min after CLCVP（T4）and immediately after surgery（T5）.Blood loss and transfusion of each group was measured.The correlation between CVP/MAP and blood loss during CLCVP were analyzed.Results When compared with T1,CVP of both groups at T4 and systemic vascular resistance index（SVRI）of CLCVP group at T2 were higher than the control group（P〈0.05）,the MAP,CVP,intrathoracic blood volume index（ITBVI）of CLCVP group during the period of CLCVP（T2-T4）and the MAP and CVP of control group at T4 were decreased（P〈0.05）.When compared with control group,the volume of blood loss,blood transfusion,urine and fluid infusion were decreased in CLCVP group（P〈0.05）.Conclusion CLCVP could reduce the blood loss and blood transfusion in patients undergoing spine surgery,and had no negative effects on hemodynamics and EVLW.

关 键 词：控制性低中心静脉压 血流动力学 胸腔内血容量 血管外肺水 失血量 

分 类 号：R614[医药卫生—麻醉学]