急性高容量血液稀释联合控制性降压对脊柱侧弯矫正术患者cTnI水平及全身炎性反应的影响  

Effects of Acute Hypervolemic Hemodilution Combined with Controlled Hypotension on cTnI Levels and Systemic Inflammatory Response in Patients Undergoing Scoliosis Correction Surgery

作　　者：张学康[1] 舒适 胡茜[1] 陆细根 张武光 李媛 赵鑫焱 方新华 ZHANG Xue-kang;SHU Shi;HU Qian;LU Xi-gen;ZHANG Wu-guang;LI Yuan;ZHAO Xin-yan;FANG Xin-hua(Department of Anesthesiology,the First Affiliated Hospital of Nanchang University,Nanchang,330006,China;Department of Anesthesiology, Xinjian County People’s Hospital,Nanchang 330100,China;Department of Anesthesiology,Pengze County People’s Hospital,Jiujiang 332700,China)

机构地区：[1]南昌大学第一附属医院麻醉科,南昌330006 [2]南昌市新建区人民医院麻醉科,南昌330100 [3]彭泽县人民医院麻醉科,江西九江332700

出　　处：《实用临床医学（江西）》2019年第9期21-25,共5页Practical Clinical Medicine

基　　金：江西省农村卫生适宜技术“星火推广计划项目”(20188011)

摘　　要：目的探讨急性高容量血液稀释(AHH)联合控制性降压(CH)对脊柱侧弯矫正术患者术中出血、肌钙蛋白I(cTnI)及全身炎症反应的影响。方法选取50例ASA分级Ⅰ—Ⅱ级脊柱侧弯矫正术患者,按随机数字表法将其分为观察组和对照组,每组25例。2组患者入手术室后补充术前禁食水所失液量,均静脉滴注乳酸林格液6~8mL·kg^-1。麻醉诱导平稳后,观察组以30mL·min^-1速度输注6%羟乙基淀粉(130/0.4)15mL·kg^-1,同时以1.0μg·kg^-1·min^-1速度泵注硝酸甘油,平均动脉压控制在8.0~9.3kPa,主要手术步骤结束时停用硝酸甘油。对照组常规补液,不行AHH及CH。分别于AHH联合CH前(对照组为术前30min,T1)、AHH联合CH后(对照组为手术开始时,T2)、手术开始后2h(T3)、手术结束(T4)、术后24h(T6)时检测血清前降钙素(PCT)、C反应蛋白(CRP)、白细胞介素6(IL-6)及肿瘤坏死因子-α(TNF-α)的水平;于T1、T2、T4、术后6h(T5)及T6时测定cTnI的水平。记录手术时间、术中失血量、自体血回输量及异体血输注量。结果观察组手术时间、出血量、回收自体血量及输注同型异体红细胞悬液量均低于对照组(P<0.05)。2组各时点cTnI水平组内及组间比较,差异无统计学意义(P>0.05)。与T1时比较:T3—T6时2组CRP水平明显升高(P<0.05);T2—T6时2组IL-6、TNF-α水平明显升高(P<0.05)。T2—T6时,观察组CRP、IL-6、TNF-α水平均低于对照组(P<0.05)。T3时仅对照组PCT浓度可以检测出;T4、T6时,观察组PCT水平均低于对照组(P<0.05)。结论AHH联合CH可减少脊柱侧弯矫正手术患者术中出血量、自体回收血量、异体输血量及手术时间;对围术期cTnI无影响,未见心肌损伤;可有效抑制围术期PCT、CRP、IL-6及TNF-α等炎性细胞因子的释放,降低全身炎症反应。Objective To observe the effects of acute hypervolemic hemodilution(AHH) combined with controlled hypotension(CH) on intraoperative hemorrhage,cTnI levels and systemic inflammatory response in patients undergoing scoliosis correction surgery. Methods Fifty ASA Ⅰ-Ⅱ patients undergoing scoliosis correction surgery were randomly divided into observation group and control group,with 25 patients in each group.After entering the operating room,patients were treated with intravenous lactated Ringer’s solution 6-8 mL·kg^-1 to compensate for preoperative fluid restriction.After anesthetic stabilization,the observation group was infused with 6% hydroxyethyl starch(130/0.4,15 mL·kg^-1 ,30 mL·min^-1 ute) and nitroglycerin 1.0 μg·kg^-1 ·min -1 ute to maintain the mean arterial pressure at 8.0-9.3 kPa.Nitroglycerin was discontinued at the end of the main surgical procedure.The control group was given conventional fluid replacement without the performance of AHH and CH.Serum levels of procalcitonin(PTC),C-reactive protein(CRP),interleukin-6(IL-6) and tumor necrosis factor(TNF-α) were detected before AHH and CH(at 30 minutes before surgery in control group C,T 1),after AHH and CH(at the beginning of surgery in control group C,T 2),at 2 hours after surgery(T 3),at the end of surgery(T 4),and at 24 hours after surgery(T 6).Furthermore,the concentrations of cTnI were measured at T 1,T 2,T 4,T 5(6 hours after surgery) and T 6.Operation time,blood loss,autogenous blood transfusion volume and allogeneic blood transfusion volume were recorded in both groups. Results Compared with control group,operation time,blood loss,autogenous blood transfusion volume and allogeneic blood transfusion volume decreased in observation group( P<0.05).There were no significant differences in cTnI levels between the two groups at all time points,as well as among different time points in each group( P >0.05).Compared with T 1,the levels of CRP at T 3-T 6 and the levels of IL-6 and TNF-α at T 2-T 6 increased in both groups( P<0.05).Compared wi

关 键 词：急性高容量血液稀释 控制性降压 脊柱侧弯矫正手术 肌钙蛋白I 炎症反应 

分 类 号：R614[医药卫生—麻醉学]