术中自体血回输联合尼卡地平控制性降压在脑动脉瘤夹闭术中的应用  

The combination of intraoperative salvage autotransfusion and controlled hypotension by nicardipine in patients which underwent intracranial aneurysmal surgery

作　　者：金琦[1] 杜少鹏 陈绪贵[1] 

机构地区：[1]北京军区总医院麻醉科,北京100700

出　　处：《中国输血杂志》2016年第3期246-248,共3页Chinese Journal of Blood Transfusion

摘　　要：目的通过观察自体血回输联合尼卡地平控制性降压对脑动脉瘤夹闭手术患者血流动力学的影响,评价2者节约用血的有效性及安全性。方法 60例在本院行脑动脉瘤夹闭术患者,根据是否应用自体血回输及尼卡地平控制性降压分为2组,每组30例,观察组(N组)应用术中自体血回输和尼卡地平控制性降压,对照组(C组)不用术中自体血回输和尼卡地平控制性降压。分别于术前(T0),降压前(T1),降压30 min时(T2),动脉瘤夹闭时(T3)及手术结束时(T4)记录HR、MAP、CVP和Hb含量,手术结束后记录手术时间、出血量、输入库血量及术中回收血量。结果 1)C组T2、T3、T4与T1比较MAP分别为(65.1±3.4,66.0±2.9)mm Hg、HR分别为(61.0±3.5,63.1±4.3)次/min、CVP无明显变化(P>0.05);N组T2、T3与T1比较MAP、HR明显降低(P<0.05)。2)2组间比较,T0及T1时刻血流动力学指标无明显差异(P>0.05);与C组比较,N组T2、T3时MAP分别为(65.1±3.4,66.0±2.9)mm Hg、HR分别为(61.0±3.5,63.1±4.3)次/min降低(P<0.05)。3)2组各时刻Hb无明显变化(P>0.05);与C组比较N组失血量[(823.6±305.4)m L]及输库血量[(163.0±104.0)m L]明显降低(P<0.05)。结论术中自体血回输联合尼卡地平控制性降压有利于脑动脉瘤夹闭术患者血流动力学稳定并能减少出血量及库血输入量,节约库血资源。Objective To observe effects of intraoperative salvage autotransfusion combined with comrolled hypotension （CH） by nicardipine on hemodynamics and to determine the efficacy and safety of combination in patients who underwent in- tracranial anemysmal surgery. Methods Sixty patients in our hospital underwent intracranial aneurysmal surgery were cho- sen as study subjects. The patients were allocated into group N （ intraoperative salvage autotransfusion ＋ nicardipine） and group C （comrol group）, with 30 in each. The HR, MAP, CVP and Hb were recorded before surgery（T0）, before CH （ T1 ）, 30rain after CH （T2）, at the moment of clipping cerebral aneurysm （ T3 ） and at the end of surgery （T4）. The volume of blood loss, blood transfusion and recycling btood were calculated at the end of surgery. Results 1 ）. HR, MAP and CVP did not change in T2, T3 compared with T1 in group C （ P 〉 0. 05 ）. In group N, the MAP, HR decreased in T2, T3 com- pared with T1 （P 〈 0.05）. 2）. The two groups had no differences in CVP, MAP and HR at TO and T1 （ P 〉 0.05 ）. In group N, the HR and MAP were lower than group C. 3）. The volume of allogeneic blood transfusion and blood loss in group N were significantly lower than group C （ P 〈 0. 05）. There was no difference in change of Hb between two groups during the surgery （P 〉 0. 05）. Conclusion The application of intraoperative salvage autotransfusion with controlled hypotension by nicardipine can keep balance of hemodynamics and its combination is safe for patients and can effectively decrease blood loss and allogeneic blood transfusion during intracranial aneurysmal surgery.

关 键 词：自体血回输 控制性降压 尼卡地平 脑动脉瘤夹闭术 

分 类 号：R457.1[医药卫生—治疗学] R651.12[医药卫生—临床医学]