急性高容量血液稀释联合控制性降压及自体血回输在神经外科手术中的应用  

Clinical Application of Acute Hypervolaemic Haemodilution Combined with Controlled Hypotension and Autologous Blood Transfusion in Neurosurgery.

作　　者：侯永超 陈卉[2] 张正辉 周述芝[2] 冉鑫 Hou Yongchao;Chen Hui;Zhang Zhenghui(Department of Anesthesiology of North Sichuan Medical College,Nanchong,Sichuan 637000;Ya an People′s Hospital,Ya an,Sichuan 625000,China.)

机构地区：[1]川北医学院麻醉学系,四川南充637000 [2]雅安市人民医院,四川雅安625000

出　　处：《四川医学》2023年第4期405-408,共4页Sichuan Medical Journal

摘　　要：目的观察神经外科手术患者中进行急性高容量血液稀释(AHH)联合控制性降压(CH)及自体血回输(ABT)对凝血功能的影响。方法选择神经外科手术患者72例随机分为对照组和试验组,试验组在对照组基础上,加用AHH联合CH及ABT治疗。比较两组患者麻醉诱导前(T0)、麻醉诱导后30min(T1)、术后1 d(T2)的血常规、动脉血气分析、凝血功能及血栓弹力图(TEG)变化,记录两组患者术中出血、输血情况及输血相关并发症。结果两组患者术中出血量差异无统计学意义(P<0.05)。与对照组比较,试验组异体血输注例数少于对照组(P<0.05);两组患者均无输血相关不良反应发生。与T0比较,两组患者T1和T2时的Hb、Hct及Plt明显降低(P<0.05);T2时试验组Hb、Hct、Plt、PaO 2明显高于对照组(P<0.05)。T1和T2时,两组患者Lac、K+、PT、APTT、ACT、FIB、MA比较,差异无统计学意义(P<0.05)。结论AHH联合CH及ABT用于神经外科手术患者可减少异体血使用量,对内环境及凝血功能无明显影响,在神经外科手术中应用安全。Objective To observe the effect of acute hypervolemic hemodilution(AHH)combined with controlled hypotension(CH)and autologous blood transfusion(ABT)on coagulation function in neurosurgical patients.Methods 72 neurosurgical patients were randomly divided into control group and experimental group.The experimental group received AHH combined with CH and ABT,while the control group did not receive the above blood conservation techniques.The changes of blood routine,arterial blood gas analysis,coagulation function and TEG before anesthesia induction(T0),30min after anesthesia induction(T1)and 1 day after anesthesia(T2)were compared between the two groups,and intraoperative bleeding,blood transfusion and transfusion related complications were recorded between the two groups.Results There was no significant difference in intraoperative amount of bleeding between the two groups(P>0.05).Compared with the control group,the number of allogeneic blood transfusion in the experimental group was lower than that in the control group(P<0.05),and no transfusion related adverse reactions occurred in either group.Compared with T0,Hb,Hct and Plt at T1 and T2 were significantly lower in the two groups(P<0.05).Hb,Hct,Plt and PaO 2 in the experimental group were significantly higher than those in the control group at T2(P<0.05).There were no statistically significant in Lac,K+,PT,APTT,FIB,ACT and MA between the two groups at T1 and T2(P>0.05).Conclusion The use of AHH combined with CH and ABT in neurosurgical patients can reduce the amount of allogeneic blood transfusion,without influence on the internal environment and coagulation function,which is safe in neurosurgery.

关 键 词：急性高容量血液稀释 控制性降压 自体血回输 神经外科手术 凝血功能 

分 类 号：R457.1[医药卫生—治疗学]