研究颅脑肿瘤手术中急性等容血液稀释对脑氧供和氧耗的影响  

Study of the effect of acute normovolemic hemodilution on cerebral oxygen supply and consumption during craniocerebral tumor surgery

作　　者：束云菲 陈伟 张永洪 SHU Yunfei;CHEN Wei;ZHANG Yonghong(Department of Anesthesiology,Mianyang Hospital Affiliated to School of Medicine,University of Electronic Science and Technology of China·Mianyang Central Hospital,Mianyang,Sichuan 621000,China)

机构地区：[1]电子科技大学医学院附属绵阳医院·绵阳市中心医院麻醉科,四川绵阳621000

出　　处：《现代医学与健康研究电子杂志》2023年第8期36-39,共4页Modern Medicine and Health Research

摘　　要：目的 探讨在颅脑肿瘤手术中采用急性等容血液稀释对患者氧代谢指标、血流动力学指标的影响。方法 采取随机数字表法将电子科技大学医学院附属绵阳医院·绵阳市中心医院2021年1月至2022年12月收治的80例进行颅脑肿瘤手术的患者分为对照组和观察组,各40例。对照组患者采用单纯控制性降压治疗,观察组患者采用急性等容血液稀释联合控制性降压治疗,两组患者均随访至出院。对比两组患者全麻插管后(T_(0))、急性等溶血液稀释后(T_(1))、控制性降压后(T_(2))、病灶切除后(T_(3))、术毕(T_(4))氧供(DO_(2))、氧耗(VO_(2))、氧摄取率(ERO_(2))、心率(HR)、平均动脉压(MAP)、中心静脉压(CVP),术中失血量、异体输血量,术前和术后1 d血容量指标水平及并发症发生情况。结果 T_(0)~T_(4)时观察组患者DO_(2)先降后升再降,ERO_(2)先升后降再升,且T_(1)~T_(4)时观察组患者DO_(2)显著低于对照组,ERO_(2)显著高于对照组;T_(0)~T_(4)时两组患者HR、MAP、CVP均有明显的波动,且观察组患者T_(2)~T_(4)时HR显著低于对照组,T_(1)~T_(4)时MAP、CVP均显著高于对照组;观察组患者失血量、异体输血量均低于对照组;与术前比,术后1 d两组患者血红蛋白、血小板、血浆纤维蛋白原水平均降低,而术后1 d观察组血红蛋白高于对照组;观察组患者并发症总发生率低于对照组(均P<0.05)。结论 急性等容血液稀释结合控制性降压不仅能够减少颅脑肿瘤手术中的失血量和异体输血量,还不影响机体氧消耗,平稳血流动力学,促进患者血容量恢复,降低并发症的发生。Objective To explore the effect of acute normovolemic hemodilution on the indexes of oxygen metabolism and hemodynamics in patients undergoing craniocerebral tumor surgery.Methods A total of 80 cases patients undergoing craniocerebral tumor surgery who were admitted to Mianyang Hospital Affiliated to School of Medicine,University of Electronic Science and Technology of China·Mianyang Central Hospital from January 2021 to December 2022 were divided into the control group and the observation group according to the random number table method,with 40 cases in each group.Patients in the control group were treated with simple controlled hypotension,while patients in the observation group were treated with acute normovolemic hemodilution combined with controlled hypotension,patients in the both groups were followed up until discharge.The levels of oxygen delivery(DO_(2)),oxygen consumption(VO_(2)),oxygen extraction ratio(ERO_(2)),heart rate(HR),mean arterial pressure(MAP),central venous pressure(CVP)after general anesthesia intubation(T_(0)),after acute normovolemic hemodilution(T_(1)),after controlled hypotension(T_(2)),after lesion resection(T_(3)),after surgery(T_(4))and the amount of blood loss and allogeneic blood transfusion and the levels of blood volum indexes before and one day after surgery and the occurrence of complications of patients were compared between the two groups.Results From T_(0) to T_(4),the DO_(2) of patients in the observation group decreased first,then increased and decreased again,and the ERO_(2) of patients in the observation group increased first,then decreased and increased again,and the DO_(2) of patients in the observation group was significantly lower than that in the control group,the ERO_(2) of patients in the observation group was significantly higher than that in the control group from T_(1) to T_(4);there were significant fluctuations in HR,MAP and CVP of patients between the two groups from T_(0) and T_(4),and the HR of patients in the observation group was significantly lower th

关 键 词：颅脑手术 急性等容血液稀释 控制性降压 氧代谢 

分 类 号：R739.41[医药卫生—肿瘤]