摘要
目的 探讨术前急性高容血液稀释联合术中控制性降压对腰椎手术病人血液动力学和氧代谢的影响。方法 择期行腰椎骨折椎板减压切开复位内固定术病人30例,随机分为二组:术前急性高容血液稀释联合术中控制性降压组(联合组)和单纯控制性降压组(对照组),每组15例。联合组术前输入6％羟乙基淀粉20 ml/kg和乳酸林格氏液20 ml/kg,行急性高容血液稀释;术中微量泵输注硝普钠0.5-6 μg·kg-1·min-1实施控制性降压,平均动脉压(MAP)控制在55-65 mm Hg;对照组术中控制性降压同联合组。观察联合组插管后稀释前即刻(T0)、稀释后降压前即刻(T1)、降压后30 min(T2)和停降压后30 min(T3)时,对照组插管后降压前即刻(T1)、降压后30 min(T2)和停降压后30 min(T3)时心率(HR)、MAP、中心静脉压(CVP)、心输出量(CO)、氧供(DO2)氧耗(VO2)以及动脉血乳酸(LA)的变化。结果 HR:联合组T1低于T0,对照组T2、T3高于T1,T3 低于 T2;联合组 T2、T3低于对照组。MAP:与T0比较,联合组T1、T3升高、T2降低;T2低于T1,T3高于T2;与T1比较,对照组T2降低、T3升高;与对照组比较,联合组T3降低。CVP:联合组T1高于T0,T2低于T1;对照组T2、T3低于T1;与对照组比较,联合组T1、T2升高。CO:联合组T1、T2高于T0,T3低于T2;联合组T1、T2高于对照组。D02:联合组T1。
Objective To investigate the influence of acute hypervolemic hemodilution (AHH) combined with controlled hypotension (CH) induced with sodium nitroprusside (NTP) on hemodynamics and tissue perfusion and oxygenation in patients undergoing spinal surgery.Methods Thirty ASA Ⅰ-Ⅱ patients aged 18-61 years, weighing 45-70 kg scheduled for decompression of spinal cord by laminectomy and internal fixation for fracture of lumbar spine were randomly divided into two groups : group I AHH + CH ( n= 15) and group Ⅱ CH alone ( n = 15). The patients were unpremedicated. Anesthesia was induced with midazolam 2-3 mg, fentanyl 0.2 mg and propofol 2.0 mg·kg-1 . Intubation was facilitated with vecuronium 0.1 mg·kg-1 . The patients were mechanically ventilated after tracheal intubation. PET CO2 was maintained at 35-45 mm Hg. Anesthesia was maintained with isoflurane 1.2%-1.6% and intermittent intravenous(i. v.) boluses of vecuronium. Radial artery was cannulated and Swan-Ganz catheter was placed via internal jugular vein after induction of anesthesia. In groupⅠ (AHH + CH) 6% HES20 ml·kg-1 and lactated Ringer's solution 20 ml·kg-1 were infused at a rate of 50 ml· min-1 after placement of S-G catheter. Intraoperative blood loss was replaced with equal volume of 6% HES. Blood was transfused when necessary to maintain Hct > 20 % . In both groups CH was induced with infusion of 0.01 % NTP at a rate 0.5-6.0 μg·kg-1·min-1 to maintain MAP at 55-65 mm Hg. MAP, HR, CVP and CO were continuously monitored. Arterial lactate concentration was measured by enzyme assay. Arterial and mixed venous blood gases were analyzed, and oxygen delivery (DO2 ) and consumption (VO2) were calculated before AHH (T0) after AHH was performed (T1), 30 min after CH was induced (T2) and 30 min after termination of CH (T3) in group Ⅰ and in group Ⅱ before CH (T1), 30 min after induction of CH (T2) and 30 rain after termination of CH (T3 ) .Results
In group Ⅰ(AHH + CH) compared with the baseline values (T0 ) HR significantly decreased while CVP significantly increased after AHH (T1 ) ; cardiac output (CO) significantly increased after AHH (T1 ) and during CH (T2) while DO2 was significantly decreased after AHH (T1) and CH (T3 ) but arterial lactate concentration was significantly decreased during and after CH (T2, T3). In group Ⅱ (CH alone) compared with the baseline values (T1) HR significantly increased while CVP significantly decreased during and after CH (T2, T3 ) ; there was no significant change in CO and DO2 at T2 and T3 but arterial lactate concentration significantly increased during and after CH (T2, T3). There was significantly less blood loss during operation in group I than in group Ⅱ . Conclusion
There was tissue deoxygenation during and after deliberate hypotension as shown by increased arterial lactate concentration while AHH combined with CH can improve tissue perfusion and oxygenation. AHH can also maintain hemodynamic stability during CH.
出处
《中华麻醉学杂志》
CAS
CSCD
北大核心
2004年第7期485-488,共4页
Chinese Journal of Anesthesiology
