急性非等容血液稀释对开颅病人颅内压及凝血功能影响  

The effect of acute non-isovolemic hemodilution on the intracranial pressure and coagulative function during nuerosurgery

作　　者：蓝仲岳[1] 岳军[1] 姜晓芬[1] 胡明伦[1] 金烈烈[1] 诸葛启钏[2] 

机构地区：[1]温州医学院第一附属医院麻醉科,325000 [2]温州医学院第一附属医院神经外科,325000

出　　处：《中国基层医药》2003年第4期292-293,共2页Chinese Journal of Primary Medicine and Pharmacy

摘　　要：目的　探讨急性非等容血液稀释对开颅病人的颅内压和凝血功能的影响。方法　选择择期开颅肿瘤切除病人 18例 ,麻醉诱导前行蛛网膜下腔穿刺 ,监测颅内压 (ICP) ,并由足背动脉放血 4 0 0～ 6 0 0ml,开始诱导同时经外围静脉快速补充 2～ 2 5倍于采血量的等效胶体和晶体。麻醉采用静吸复合全麻 ,术中连续监测有创血压、心率、氧饱和度 ,分别于血液稀释前后监测ICP ,中心静脉压 (CVP)、活化部分凝血活酶(APTT)、凝血酶原时间 (PT)、凝血因子Ⅰ (FIB)、血小板 (PLT)、血球压积 (HCT)。结果　与血液稀释前相比 ,血流动力学稳定 ;PT明显延长 (P <0 0 5 ) ,PLT、HCT明显降低 (P <0 0 5 ) ,但仍在正常范围内 ,APTT、FIB差异无显著意义 (P >0 0 5 ) ;颅内压无明显增高。结论　急性非等容血液稀释对开颅手术病人的颅内压和凝血功能无明显影响 ,是一种安全有效的、简便的血液保护方法。Objective To investigate the effect of acute non isovolemic hemodilution(ANIH) on the intracranial pressure(ICP) and coagulative function during nuerosurgery.Methods Eighteen patients scheduled for selective operation were studied.Before anaesthesia,lumber puncture was performed for ICP monitoring,hemodilution was achived by the removal of 400～600ml autologous blood from dorsalis pedis artery and replacement with 2～2.5 twice volume of oncotic tonic solution.Anaesthesia were maintained with progpofol isoflurane vencuronium.Continuous monitor of arterial blood pressure,heart rate,arterial oxygen saturation were made.ICP,CVP,APTT,PT,FIB,blood platelet,HCT were detected before and after hemodilution.Results Compared with pre hemodilution,there were significant difference of PT,blood platelet and HCT(P<0.05) which were still within the normal range.There were no significant difference of ICP,APTT,FIB and the hemodynamic parameters had no significant change.Conclusion ANIH had no significant enfluence on intracranial pressure(ICP) and coagulative function,which is a safety and simple method for blood protect.

关 键 词：急性非等容血液稀释 开颅 颅内压 凝血功能 麻醉 蛛网膜下腔穿刺 血流动力学 凝血因子1 凝血活酶 凝血酶原时间 血小板 血球压积 

分 类 号：R614[医药卫生—麻醉学]