摘要
目的 观察患者围术期血气变化 ,研究果糖二磷酸钠 (FDP)和氢化可的松对重大手术中大量输血引发低氧血症的治疗作用 .方法 大量输血患者 85例分为 2组 :治疗组 6 0(男 42 ,女 18)例 ,年龄 13～ 80岁 ,术中用果糖二磷酸钠与氢化可的松治疗 ;对照组 2 5 (男 17,女 8)例 ,年龄 14～ 6 4岁 ,未作上述治疗 .治疗组与对照组均于麻醉前 (不吸氧 ) ,插管后(吸纯氧 ) ,术后吸纯氧和术后不吸氧时 ,分别抽取动脉血进行血气分析 ,比较两组患者术前及术后PaO2 和 (A a)DpO2 的变化 .结果 术前治疗组和对照组PaO2 和 (A a)DpO2 无明显差异 (P >0 .0 5 ) .治疗组吸入空气时 (FiO2 ≈ 0 .2 1) ,PaO2 术后明显低于术前 (kPa ,8.0± 0 .6vs 11.5± 0 .7,P <0 .0 1) ,(A a)DpO2 则明显升高 (kPa ,4.9± 0 .7vs 1.0± 0 .7,P <0 .0 1) ;吸入纯氧 (FiO2 ≈ 1.0 )时 ,PaO2 术后也明显低于术前(kPa,39.2± 4.8vs 6 1.0± 5 .5 ,P <0 .0 1) ;(A a)DpO2 也明显升高 (kPa,2 5 .5± 6 .0vs 9.9± 7.0 ,P <0 .0 1) .无论在吸入空气或吸入纯氧 ,治疗组术后PaO2 和 (A a)DpO2 不明显 .结论 大量输血导致术后PaO2 降低和 (A a)DpO2 增大 ,早期应用果糖二磷酸钠和氢化可的松可有效地减少PaO2 降低的程度以及 (A a)DpO2 增大的程度 。
AIM To study the clinical effect for patient with hypoxemia and massive blood transfusion treated by fructose 1, 6 diphosphatase and hydrocortisone. METHODS Eighty five patients received massive blood transfusion were divided into receiving the therapy of the fructose 1, 6 diphosphatase and the hydrocortisone which were used in high dose during intraoperative period (treatment, n =60) and the control therapy which do not used the medicament above mentioned (control, n =25). The arterial blood samples were taken from radial artery before intubatton (FiO 2≈ 0.21 ), 30 min after intubatton (FiO 2≈1.0), immediately before removing tube (FiO 2≈1.0) and 15 min after removing tube (FiO 2≈ 0.21 ) for the blood gas analysis. Then compared with the intraoperative changes of arterial oxygen partial pressure (PaO 2) or alveolar arterial PO 2 difference (A a)DpO 2 between two groups. RESULTS Compared with those in two groups, the PaO 2 and(A a)DpO 2 have no difference in preoperative period ( P >0.05). When the patients' breathing with the air (FiO 2≈0.21) in treatment group, the PaO 2 were significantly lower(kPa,8.0±0.6 vs 11.5±0.7, P <0.01)in postoperative period than those in preoperative period, while the (A a)DpO 2 were obviously high (kPa,4.9±0.7 vs 1.0 ±0.7, P <0.01). In the same way, the patients' breathing with the pure oxygen (FiO 2≈1.0) in control group, the PaO 2 were significantly reduced (kPa,39.2±4.8 vs 61.0± 5.5 , P <0.01)in postoperative period, while the (A a)DpO 2 were obviously increased (kPa,25.5±6.0 vs 9.9±7.0, P <0.01) at one time. Irrespective of the patients' breathing with the air (FiO 2≈0.21) or the pure oxygen (FiO 2≈1.0), both the PaO 2 and P(A a) O 2 have an obvious change in postoperative period than in preoperative period ( P <0.01). CONCLUSION Massive blood transfusion can induce hypoxemia, and fructose 1, 6 diphosphatase and hydrocortisone has a positive effect.
出处
《第四军医大学学报》
北大核心
2001年第15期1433-1435,共3页
Journal of the Fourth Military Medical University
关键词
果糖二磷酸钠
氢化可的松
输血
低氧血症
呼吸窘迫综合征
fructose 1, 6 diphosphatase
hydrocortisone
hypoxemia
venous blood transfusion
respiratory distress syndrome
