摘要
目的 探讨术前急性高容量血液稀释对正颌外科病人血液动力学和凝血功能的影响，评估该方法临床应用的价值。方法 选择择期行正颌外科双颔手术的病人40例，随机分为ABCD四组，每组10例。A为贺斯实验组。术前输注6％羟乙基淀粉和乳酸林格液各占总量1／2，行急性高容血液稀释；B为贺斯对照组，用6％羟乙基淀粉和乳酸林格液补充术中丢失血液和体液；C为佳乐施实验组，术前输注4％琥珀酰明胶和乳酸林格液各占总量1／2，行急性高容血液稀释；D为佳乐施对照组，用4％琥珀酰明胶和乳酸林格液补充术中丢失血液和体液。四组病例术中均采用硝普钠控制性降压，平均动脉压（MAP）控制在50～60mmHg。实验组在插管后稀释前即刘（T0），稀释后手术开始前即刻（T1），手术结束即刻（T2），术后第一日8AM（T3）时；对照组在手术开始前即刻（T1），手术结束即刘（T2），术后第一日8AM（T3）时，记录RBC、HBG、HCT及凝血指标的变化，以及血液动力学的变化。结果 MAP：A、C组T1低于T0（P〈0．01）；T2高于T1（P〈0．01）。HR：A、C组T2高于T0、T1（P〈0．01）。RBC、HGB、HCT和PLT：A、C组T1低于T0（P〈0．01），T3升高超过T1且接近T0。结论 术前急性高容量血液稀释对正颌外科病人血液动力学的稳定影响小，能减少血液的丢失。贺斯与佳乐施两种胶体液均可引起部分凝血指标的改变，但二者均不影响凝血功能。可以作为正颌外科手术选择性应用的一种有效的辅助方法。
Objective To investigate the effects of acute hypervolemic hemodilution（AHH） on the function of blood coagulation and hemodynamics to the patients in orthognathic surgery, and to evaluate its appliance on orthognathic surgery. Methods Forty patients in orthognathic surgery chosen according to the schedule were randomized to four groups and 10 each. HES experimental group （group A） were infused with half and half of 6 % hydroxyethyl starch（HES） and Lactate Ringer＇s solution before surgery. HES control group （group B） were infused with 6 % hydroxyethyl starch and Lactate Ringer＇s solution to eomplement the blood and liquid loss during surgery. Gelofusin experimental group （group C） were infused with half and half of 4% succinyl gelatin （Gelofusine） and Lactate Ringer＇s solution before surgery. Gelofusine control group （group D） were infused with 4 % succinyl gelatin and Lactate Ringer＇s solution to complement the blood and liquid loss during surgery. Mean artery press（MAP） of patients in all groups was controlled between 50 to 60 mmHg with sodium nitroprusside deliberated hypotension. RBC, HBG, HCT, the change of blood coagulation index and the change of hemodynamies were recorded before AHH（T0）, before surgery （T1）, at the end of surgery （T2）, 8 AM of the first day after surgery （T3） in the two experimental groups; before surgery （T1）, at the end of surgery （T2）, 8 AM of the first day after surgery （T3） in the two control groups. Results In group A and C, MAP was lower at T1 than at To（ P 〈0.01）, and was higher at T2 than at T1（ P 〈0.01）. In group A and C, HR was higher at T2 than at T0 and T1（ P 〈0.01）. In group A and C, RBC,HGB,HCT and PLT were lower at T1 than at T0（ P 〈0.01）. RBC, HGB,HCT and PLT were higher at T3 than at T1, close to T0. Conclusion Acute hypervolemic hemodilution（AHH） has rare effect on the hemodynamics in patients undergoing orthognathic surgery. And AHH can reduce haemorrhage. HES and Gelofusine can bring the change of some blood coagulation index. But neither of them would affect the function of blood coagulation. AHH is a effective way and facilitatory to orthognathic surgery.
出处
《现代口腔医学杂志》
CAS
CSCD
北大核心
2007年第2期153-155,共3页
Journal of Modern Stomatology
关键词
急性高容量性血液稀释
正颔外科
贺斯
佳乐施
Acute hypervolemic hemodilution （AHH） Orthognathic surgery 6 % hydroxyethyl starch （HES） 4 % succinyl gelatin（Gelofusine）
