AHH联合控制性降压对脊柱手术患者内环境稳态和失血的影响  

Influence of acute hypervolemic hemodilution combined with controlled hypotension on homeostasis and blood loss in patients with spinal operation

作　　者：解永强 赵顺来 李莉 龚亚娜 张艳杰 XIE Yongqiang;ZHAO Shunlai;LI Li;GONG gana;ZHANG Yanjie(Hand ＆ Foot Surgery, Fourth People＇s Hospital of Langfang City, Langfang, 065700, China;Bone Surgery, Fourth People＇s Hospital of Langfang City;2 Department of Ophthalmology, Fourth People＇s Hospital of Langfang Cit;First Division of Medical Department, Fourth People＇s Hospital of Langfang City;Clinical Laboratory,Bazhou Maternity and Child Care)

机构地区：[1]廊坊市第四人民医院手足外科,河北廊坊065700 [2]廊坊市第四人民医院骨外科 [3]廊坊市第四人民医院眼科 [4]廊坊市第四人民医院内一科 [5]霸州市妇幼保健院检验科

出　　处：《临床血液学杂志（输血与检验）》2018年第3期442-445,共4页Journal of Clinical Hematology(Blood Transfusion & Laboratory Medicine)

摘　　要：目的:探讨急性高容血液稀释(AHH)联合控制性降压(CH)对脊柱手术患者内环境稳态和失血的影响。方法:选取择期脊柱手术患者80例,随机分为观察组和对照组各40例。麻醉平稳后观察组输注6%羟乙基淀粉130/0.4(6%HES 130/0.4)15 ml/kg,使血容量增加20%左右,同时以硝酸甘油行CH,输注速度为1μg·kg-1·min-1,平均动脉压控制在65~75 mmHg(1 mmHg=0.133kPa);对照组仅行CH。记录观察组AHH前(T_0)、AHH后CH前(T_1)、CH开始后30min(T_2)、停止CH后30min(T_3)及对照组CH前(T_1)、CH开始后30min(T2)、停止CH后30min(T_3)动脉血pH值、血乳酸(Lac)、血糖(BG)、剩余碱(BE)及Na^+、K^+、Ca^(2+)、Cl^-浓度。根据失血前后红细胞比容(Hct)的差值推算失血量。结果:(1)观察组pH值T_1、T_2、T_3时较T0时明显降低(P<0.05),但在正常范围内。2组T2、T3时BG明显升高(P<0.05),但对照组升高程度高于观察组(P<0.05)。2组各时点Lac、BE及Na^+、K^+、Ca^(2+)、Cl^-浓度差异无统计学意义(P>0.05)。(2)观察组失血量、输血量明显少于对照组,尿量明显多于对照组,差异均有统计学意义(P<0.05)。结论:AHH联合CH应用对脊柱手术患者内环境稳态无明显不良影响,但可显著减少患者术中失血及异体血输注量。Objective：To explore the influence of acute hypervolemic hemodilution（AHH）combined with controlled hypotension（CH）on homeostasis and blood loss in patients with spinal operation.Method：80 cases of patients with spinal operation were enrolled in this study.All patients were divided randomly into observation group（n=40）and control group（n=40）.The patients in observation group were infused 6% hydroxyethyl starch 130/0.4（6% HES 130/0.4）15 ml/kg at a rate of 30 ml/min after anesthesia,so that blood volume increased by about20%,and CH was induced with nitroglycerin at a rate of 1μg/kg/min,and to keep mean arterial pressure at 65 to75 mmHg.The patients in control group were received CH only.Arterial blood pH value,blood lactic acid（Lac）,blood glucose（BG）,residual alkali（BE）and concentration of Na＋,K＋,Ca2＋,Cl- were recorded before AHH（T0）,before CH（T1）,30 min after CH（T2）,30 min after stopping CH（T3）in observation group and before CH（T1）,30 min after CH（T2）,30 min after stopping CH（T3）in control group.Blood loss was estimated according to the difference value of erythrocyte hematocrit（Hct）.Result：（1）Compared with T0,pH value at T1,T2,T3 decreased significantly（P〈0.05）in observation group,but in the normal range.BG at T2,T3 increased significantly（P〈0.05）in two groups,but increased degrees in control group were higher than those in observation group（P〈0.05）.The differences of Lac,BE and Na＋,K＋,Ca2＋,Cl-concentration between two groups were no statistical significance（P〉0.05）.（2）The amount of blood loss in observation group was less obviously than that in control group,urine was more significantly than that in control group,the differences had statistical significance（P〈0.05）.Conclusion：AHH combined with CH have no obvious adverse effects on homeostasis in patients with spinal surgery,but can decrease significantly intraoperative blood loss and allogeneic blood transfusion.

关 键 词：急性高容血液稀释 控制性降压 内环境稳态 失血 脊柱手术 

分 类 号：R681.5[医药卫生—骨科学]