急性高容量血液稀释联合控制性降压对老年脊柱手术患者血管外肺水的影响  

Effect of Acute Hypervolemic Hemodilution Combined with Controlled Hypotension on Extravascular Lung Water in Elderly Spinal Surgery Patients

作　　者：金新蒙 张传青 任芹[2] 杨铁毅[1] 卢明军 JIN Xinmeng;ZHANG Chuanqing;REN Qin;YANG Tieyi;LU Mingjun(Department of Orthopedics,Gongli Hospital of the Second Military Medical University,Shanghai 200135,China;Department of Anesthesiology,Gongli Hospital of the Second Military Medical University,Shanghai 200135,China)

机构地区：[1]第二军医大学附属公利医院骨科,上海200135 [2]第二军医大学附属公利医院麻醉科,上海200135

出　　处：《宁夏医科大学学报》2021年第2期129-132,共4页Journal of Ningxia Medical University

基　　金：上海市浦东新区重点学科群(PWZxp2017-10)。

摘　　要：目的探讨急性高容量血液稀释(AHH)联合控制性降压(CH)对老年脊柱手术患者血管外肺水的影响。方法选择行脊柱手术老年患者60例,分为对照组、AHH组、AHH联合CH组,每组各20例。分别于诱导前(T1)、诱导后5 min(T2)、手术关键步骤结束(T3)、手术结束(T4)、拔管后(T5)5个时间点,记录患者的心率(HR)、平均动脉压(MAP)、中心静脉压(CVP)、心排血指数(CI)、胸内血容量(ITBV)、血管外肺水(EVLW)的变化,以及手术时间、出血量、尿量和异体输血情况。结果AHH联合CH组术中出血量少于对照组和AHH组(P均<0.05),且无1例输注异体血;AHH组术中异体输血率和输血量减少(P均<0.05)。与T1时比较,T2~T4时AHH联合CH组MAP降低,AHH组CVP升高(P均<0.05),对照组T3和T4时CI降低(P均<0.05)。与T1和对照组比较,AHH组T2~T5时ITBV和EVLW均升高(P均<0.05),AHH联合CH组T2~T5时ITBV和EVLW差异均无统计学意义(P均>0.05)。结论AHH联合CH应用于老年患者能起到更好的血液保护作用,且对血管外肺水无不良影响。Objective To investigate the effect of acute hypervolemic hemodilution(AHH)combined with controlled hypotension(CH)on extravascular lung water in elderly patients undergoing spinal surgery.Methods Sixty patients with selective spinal surgery were enrolled in our hospital.They were randomly and equally divided into control group,AHH group and AHH combined with CH group.The HR,MAP,CVP,cardiac index(CI),intrathoracic blood volume(ITBV)and extravascular lung water(EVLW)were recorded at 5 time points:before anesthesia induction(T1),5 minutes after anesthesia induction(T2),immediately after operative critical steps(T3),immediately after surgery(T4),and after extubation(T5).Meanwhile the operation time,blood loss,urine volume and allogeneic blood transfusion were documented.Results The blood loss in AHH combined with CH group was significantly lower than that in control group and AHH group(P all<0.05),and there was no case of allogeneic blood transfusion.The rate and volume of allogeneic blood transfusion were significantly decreased in AHH group(P all<0.05).Compared with T1,MAP was significantly reduced in AHH combined with CH group from T2 to T4(P all<0.05),CVP was notably increased in AHH group from T2 to T4(P all<0.05),and CI was significantly declined in control group at T3 and T4(P all<0.05).Compared with T1 and control group,ITBV and EVLW were notably increased in AHH group from T2 to T5(P all<0.05),while ITBV and EVLW in AHH combined with CH group were not significantly different(P all>0.05).Conclusion Acute hypervolemic hemodilution combined with controlled hypotension can provide better blood protection for elderly patients and has no adverse effects on extravascular lung water.

关 键 词：急性高容量血液稀释 控制性降压 血管外肺水 胸腔内血容积 老年 

分 类 号：R687.3[医药卫生—骨科学]