摘要
目的观察急性高容量血液稀释联合硝酸甘油控制性降压用于脊椎手术的临床效果。方法将180例择期脊椎手术病人随机分为A、B、C 3组,每组60例。手术开始前,A组输注乳酸林格氏液及6%羟乙基淀粉;B组输注乳酸林格氏液及6%羟乙基淀粉,手术开始的同时以平均动脉压（MAP）基础的70%-80%为目标,经微量泵静脉输入硝酸甘油行控制性降压,根据MAP、心率（HR）及中心静脉压（CVP）变化调节用药速度,术毕停止降压;C组病人快速输注大量乳酸林格氏液及6%羟乙基淀粉,在手术开始的同时以MAP基础的70%~80%为目标,经微量泵静脉输入硝酸甘油行控制性降压,根据MAP、HR及CVP变化调节用药速度,手术结束时停止降压。3组病人术中失血量大于血容量的20%时输注浓缩红细胞,术中连续监测MAP、HR、心电图（ECG）、CVP、呼气末二氧化碳分压（PETCO2）及血氧饱和度（SPO2）,分别于术前（T1）,术后1 h（T2）及术后24 h（T3）抽血测Hb、红细胞比容（Hct）和血小板（Plt）,记录术中出血量、输血量、尿量及输液量。结果3组病人年龄、性别、体质量等均无显著性差异。B、C组与A组相比,手术时间缩短（P〈0.05）,术中出血量减少（P〈0.05）。手术开始后1 h,A、B 2组病人HR较术前明显增快（P〈0.01）;而C组病人HR无明显变化（P〈0.05）。术毕时B组病人MAP较术前升高（P〈0.05）;C组病人CVP与术前比较有升高但无显著性差异（P〉0.05）,A、B 2组病人CVP无明显变化。A、B、C 3组病人于手术开始后1 h及术毕Hb、Hct、Plt均显著降低（P〈0.01）。结论急性高容量血液稀释联合硝酸甘油控制性降压用于脊柱手术可明显减少病人术中出血量,提供清唽术野,缩短手术时间,同时对血流动力学、组织器官血流灌注等未见明显影响,是一种安全有效的临床血液保护方法。
Objective To observe the clinical effect of acute blood dilution and Nitroglycerin control of blood pressure in the vertebra surgery. Methods One hundred and eighty patients in vertebra surgery were randomly divided into A, B and C group,the patients in Group A are injec ted with LRS and 6%hydroxyethyl starch before surgery;the patients in Group B were injected with LRS and 6% hydroxyethyl starch before surgery and were injected smoothly with Nitroglycerin through Micro-pump to control pressure with the aim of 70%-80% of MAP according to the change of MAP,HR and CVP upon operation, and the injection of Nitroglyceri the end of surgery; the patients in Group C were injected quickly with lots hydroxyethylstarch before surgery and were injected smoothly with Nitroglyceri n was stopped in of LRS and 6% n through Micropump to control pressure with the aim of 70%--80% of MAP according to the change of MAPHR and CVP upon operation,the injection of Nitroglycerin was stopped in the end of surgery. The patients were transfused with CRBC when losing blood was over 20% blood capacity in surgery. Meanwhile,MAP, HR, ECG, CVP, PETCO2 and SPO2 were monitored, and Hb, Hct and Plt in blood were detected and the amount of outlet of blood, blood transfusion, and liquid transfusion were recorded at T1 before operation,at T2 an hour after operation and at T3 24 hours after operation respectively. Results The demographic data,including age,sex and body weight were comparable among the three groups. Compared with that of Group A, the surgery time of other two groups shortened and the bleeding amount differed significantly. And HR quickened rapidly in Group A and B one hour after operation （P〈0.01） ,while HR in Group C remained unchanged. Meanwhile MAP in Group B increased after operation（P〈0.05）,and CVP in Group C increased without significant difference, but CVP in Group A and B remained the same as before operation. Clearly, Hb, Hct and Plt of patients in every group all reduced significantly at the end of operation （P〈0.01）. Conclusion Acute blood dilution and Nitroglycerin control of blood pressure can markedly reduce bleeding, shorten operation time in the vertebra surgery. And the blood dynamics and perfusion in tissue and organs are affected insignificantly. It＇s a safe and effective method of pressure control in vertebra surgery.
出处
《实用临床医学（江西）》
CAS
2009年第8期32-35,共4页
Practical Clinical Medicine
关键词
高容量
血液稀释
联合控制性降压
脊柱手术
high capacity
blood dilution
controllability falls the pressure
vertebra surgery
