不同种类液体急性等容血液稀释对脊柱手术患者血流动力学的影响和血液保护效应  

The effect of hemodynamics and blood protection of acute normovolemic hemodilution composed of different fluids in spinal surgery

作　　者：孟祥雪[1] 鲍红光[2] 顾飞[3] 张晓群[1] 耿强[4] 斯妍娜[2] 许常娥 徐亚杰[2] 

机构地区：[1]连云港市第二人民医院麻醉科,222023 [2]南京医科大学第三临床医学院 南京市第一医院麻醉科 [3]连云港市第二人民医院骨科,222023 [4]连云港市第二人民医院科教处,222023

出　　处：《临床麻醉学杂志》2016年第1期15-19,共5页Journal of Clinical Anesthesiology

摘　　要：目的观察不同种类液体急性等容血液稀释（ANH）对脊柱手术患者血流动力学的影响和血液保护效应。方法选择择期全麻下行后路脊柱手术的患者60例,男30例,女30例,年龄48~65岁,ASAⅠ或Ⅱ级,随机分为三组：ANH晶体组（A组）、ANH胶体组（B组）和对照组（C组）,每组20例。A组和B组在俯卧位全麻下行ANH,目标Hct为32%,A组放血同时用3倍体积的复方乳酸钠稀释,B组放血同时用相同体积的羟乙基淀粉130/0.4氯化钠注射液稀释,C组不做ANH,为对照组。记录ANH前5 min（俯卧位后5 min,T0）、ANH结束后10 min（切皮前5 min,T1）、输血（包括异体血和自体血）前5min（T2）和输血结束后10min（T3）的MAP、HR、心脏指数（CI）、每搏量变异度（SVV）、Hb、Hct、Plt、凝血酶原时间（PT）、活化部分凝血活酶时间（APTT）及BIS和体温;监测三组术中出血量、输血量（包括悬浮红细胞、血小板和新鲜冰冻血浆）、输注异体血患者例数、输液量及尿量。结果 T2、T3时A组MAP明显低于,SVV明显高于T0时和B、C组（P〈0.05）;T1时A、B组CI明显高于T0时和C组（P〈0.05）,T2、T3时B、C组CI明显高于T0时和A组（P〈0.05）;T1、T3时A、B组Hb、Hct及Plt明显低于T0时（P〈0.05）;T1、T2时A、B组Hb、Hct及Plt明显低于C组,T3时明显高于C组（P〈0.05）;T2、T3时三组PT及APTT明显长于T0时,T3时A、B组PT及APTT明显短于C组（P〈0.05）。A、B组术中未输入悬浮红细胞,输入悬浮红细胞及输注异体血患者例数明显少于C组（P〈0.05）;A组晶体液输入量明显多于B、C组,B组明显少于C组（P〈0.05）;A、C组胶体液输入量明显少于B组（P〈0.05）;A组尿量明显多于B、C组（P〈0.05）。三组术中出血量差异无统计学意义。结论 ANH可减少脊柱手术患者术中异体悬浮红细胞的输入量,有利于凝血功能的恢复,具有明显的血液保护效应;胶体液行ANH的扩容效果优于晶体液�Objective To observe the blood protective effects of acute normovolemic hemodilution （ANH）of different fluids on patients undergoing spinal surgery.Methods Sixty patients （male 30 cases, female 30 cases, aged 48-65 years old, ASA grade I or 11 ） undergoing posterior spinal surgery under general anesthesia were randomly divided into 3 groups （n=20） ： ANH crystalloid group （group A）, ANH colloid group （group B） and the control group （group C）. Patients in group A and group 13 were given ANH after general anesthesia, and the target Hct was 32%. The blood in group A was replaced with three times of that volume of compound sodium lactate, while the blood in group 13 was replaced with an equal amount of 60/oo hydroxyethyl starch. The MAP, HR, CI, SW, Hb, Hct, PIt,PT,APTT,13IS and temperature were recorded 5 rain before ANH（5 rain after the use of prone position） （T0）, 10 rain after ANH（5 min before skin incision） （TI）, 5 min before blood transfusion （including allogeneic and autologous blood）（T2 ）, 10 min after blood transfusion（T3 ） in three groups. The volume of blood loss, the volume of blood transfusion including suspended red blood cells （RBC）, platelet and fresh frost plasma, the cases received allogeneic blood, the volume of fluid infused and the urine output during operation were all detected in three groups. Results At T2 and T3, theMAP was significantly lower and SVV was significantly higher in group A than those in group B, C and at To （P〈0.05）. Compared with group C and at To, CI increased in group A and group B at T1 （P〈0. 05）. The CI in group B and C at T2 and T3 were higher than that in group A and at To （P〈 0. 05）. The Hh, Hct and Plt in group A and B at T1-T3 were significantly lower than those and at To （P〈0. 05）. The Hb, Hct and Plt in group A and B were significantly lower than those in group C at T1-T2 while higher than those in group C at T3 （P〈0.05）. When the PT and APTT in three groups at T2 and Ta were longe

关 键 词：晶体液 胶体液 急性等容血液稀释 脊柱手术 

分 类 号：R614[医药卫生—麻醉学]