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作 者:徐霞[1] 胡礼宏 XU Xia, HU Lihong.(The department of anesthesiology of NingBo medical center of LiHuili Hospital, NingBo 315000, Chin)
机构地区:[1]宁波市医疗中心李惠利医院麻醉科,宁波315000 [2]宁波市医疗中心李惠利东部医院麻醉科,宁波315000
出 处:《实用医学杂志》2018年第5期787-790,共4页The Journal of Practical Medicine
基 金:宁波市社会发展项目(编号:2012C50026)
摘 要:目的观察中度急性等容量血液稀释对腹腔镜前列腺癌根治术患者脑氧代谢的影响。方法选择择期行腹腔镜前列腺癌根治术患者60例,随机均分为对照组和观察组,对照组为常规输液,观察组采用羟乙基淀粉行中度急性等容量血液稀释,于全麻插管后10 min(T_1)、稀释后10 min(T_2)、二氧化碳气腹和Trendelenburg体位后30 min(T_3)和手术结束时(T_4)4个时间点,经颈内静脉球部和桡动脉采血进行血气分析,计算CERO2、CaO_2、CjvO_2、SjvO_2、Da-jvO_2及VADL等指标,记录术中出血量、输血例数和输血量。结果观察组未输入异体血,对照组异体输血率和输血量显著高于观察组(P<0.05)。观察组DajvO_2在T_2和T_3显著低于对照组。两组患者SjvO_2和CERO_2组间比较差异无显著性。VADL在各时间点组内和组间比较无统计学差异(P>0.05)。结论中度等容量血液稀释不影响患者脑氧供和脑氧代谢,可以安全有效的应用于腹腔镜前列腺癌根治术中,达到节约用血目的。Objective To observe the effect of moderate acute normovolemic hemodilutionon (ANH) on the cerebral oxygenation in patients undergoing laparoscopic radical prostateetomy. Methods Sixty patients receiv- ing laparoscopic radical prostatectomy were randomly and equally divided into control group and observation group. Patients of observation group were received ANH, but patients of control group were received routine infusion. The artery and the ball portion of the internal jugular vein blood were sampled for blood gas analysis at the time points of 10min after intubation ( T1 ), 10 min after ANH (T2), 30 min (T3) after pneumoperitoneum and Trendelenburg po- sition, the end of surgery (T4). To calculate oxygen content of arterial, and the hall portion of the internal jugular vein, cerebral oxygen uptake rate, the arterial internal jugular vein bulbar oxygen differenceand lactate difference between the artery and vein, oxygen saturation of internal jugular vein bulbar, to record the bleeding volume, the cases and volume of blood transfusion. Results observation group were not transfuse any allogeneie blood, the vol- ume and cases of allogeneic blood transfusion of control group were significant higher than observation group (P 〈 0.05 ). The Da-jvO2 of observation group were significant lower than those of control group at T2 and T3 (P 〈 0.05 ). There were no significant difference between the two groups of SjvO2, CERO2 and VADL(P 〉 0.05 ). Conclusions The application of moderate acute normovolemie hemodilutionon in patients undergoing laparoscopic radical prosta- teetomy can effectively decrease the volume of allogeneic blood transfusion, don' t infect the oxygen providing of brain and the cerebral oxygenation.
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