摘要
【目的】观察急性超容性血液稀释(AHHD)与控制性降压(CH)联合应用对脊柱手术病人血流动力学、氧供、氧耗及动脉血乳酸浓度的影响。【方法】20例拟行脊柱手术病人,麻醉诱导后25min内输入60g/L的羟乙基淀粉(贺斯200/0.5,HES)15mL/kg。手术开始时用硝酸甘油+艾司洛尔进行控制性降压,维持平均动脉压(MAP)(60±5)mmHg。主要手术操作完成后停止降压。术中连续监测心率(HR)、血压(BP)、中心静脉压(CVP)、心输出量(CO)。分别于诱导后动静脉置管完成时(基础值,T0)、手术开始即刻(AHHD后,T1)、手术开始后60min(T2)和停止降压后30min(T3)同时取动、静脉血进行血气分析及检测动脉血乳酸(LA)。据氧动力学值计算氧供(DO2),氧耗(VO2),氧摄取率(ERO2)。取同期20例仅行术中CH,未行AHHD的脊柱手术患者作对照组,对比两组术中输血量及手术前后Hct、Hb变化。【结果】试验组CVP、CO在T1、T2、T3各时点均明显高于T0值(P<0.05或P<0.01),但仍在正常值范围内。在T1-3时点试验组Hct、Hb明显降低(P<0.01)。DO2在T1时点明显升高(P<0.05),在T2时点明显降低(P<0.05)。ERO2在T2时点明显高于T0值(P<0.05)。试验组VO2和LA在各时点差异无统计学意义(P>0.05)。与对照组比较,试验组输异体血比率明显减少(P=0.001),而手术前后Hct、Hb无明显差异。术后随访两组病人均无并发症发生。【结论】AHHD与CH联合可安全用于骨科脊柱手术,并明显减少术中异体血用量。
[Objective] To observe the effects of acute hypervoleraic hemodilution （AHHD） combined with controlled hypotension （CH） on hemodynamics, oxygen transport and consumption, and the changes of lactic acid. [Methods] Twenty patients scheduled to receive spinal surgery were infused with 60 g/L HES （15 mL/kg） before operation in 25 min after induction of anesthesia. Controlled hypotension was induced with nitroglycerin and esmolol to maintain mean arterial pressure at 55-65 mmHg, which was stopped after the main surgery procedure done. HR, BP, CVP and cardiac output （CO）（using non-invasive NCCOM-3） were continuously monitored throughout operation. Arterial and central venous blood samples were taken for blood gas analysis and determination of lactic acid concentration （LA） at four time points. Oxygen delivery （DO2）, oxygen consumption （VO2, and oxygen extraction ratio （ERO2） were calculated. Another 20 patients undergoing spinal surgery without AHHD were observed as control. [Results] CVP and CO of the test group increased significantly after AHHD at T1-3（P 〈 0.05 or P 〈 0.01） but within normal range. Hct and Hb decreased significantly after AHHD as compared to the value at T0 in control group （P 〈 0.01）. DO2 were significantly higher at T1than at T0（P〈 0.05）, but were significantly lower at T2 （P 〈 0.05）. ERO2 was higher at T2 （P 〈 0.05） than at T0. There was no significant change in VO2and LA （P 〉0.05）.Compared with the control group, the ratio of homologous packed RBC transfused was significantly lower （P=0.001）.There were no significant difference in Hct and Hb before and after operation between the two groups （P 〉0.05）. No complications resulted from CH or AHHD in any of the groups. [Conclusion]Our data suggest that AHHD of moderate degree can be combined with CH to improve blood conservation in the patients receiving surgery.
出处
《中山大学学报（医学科学版）》
CAS
CSCD
北大核心
2005年第5期587-591,共5页
Journal of Sun Yat-Sen University:Medical Sciences
关键词
血液稀释
控制性降压
脊柱手术
hemodilution
controlled hypotension
spinal surgery
