摘要
目的观察急性高容血液稀释(AHH)联合右美托咪定控制性降压对腰椎手术患者的节约用血效果及安全性,以及对血流动力学的影响。方法 90名择期手术患者随机分成3组:A组为对照组;B组为AHH组;C组为AHH联合右美托咪定控制性降压组。术中持续监测MAP、HR、CVP;于AHH前(T0)、AHH后30 min(T1)、AHH后60 min(T2)、手术结束前60 min(T3)、手术结束拔管时(T4)测定Hct、Hb、Plt、PT、APTT、纤维蛋白原浓度(Fg),记录术中出血量、异体血输注量。比较各时点Hct、Hb、Plt、PT、APTT变化及血流动力学变化情况。结果 C组失血量显著低于A组(P<0.01),也低于B组(P<0.05),B、C组Hct、Hb在AHH后和术毕较AHH前降低(P<0.05),2组PT、APTT在AHH后和术毕较AHH前均延长(P<0.05),而Fg低于AHH前(P<0.05),但均在正常范围。C组未输入异体血,B组输异体血量平均为(601±96)mL,A组为(106±110)mL,3组比较差异有统计学意义(P<0.05),手术结束拔管时(T4)A、B组心率、血压均显著高于C组(P<0.01),A、B组均有病例术后出现躁动,而C组没有,比较差异有统计学意义(P<0.05)。3组均无肺水肿、心衰及创面异常出血等并发症。结论 AHH联合右美托咪定控制性降压,可以提高节血效果和改善微循环,并明显减少术中出血量甚至避免异体输血,并且对机体的血液动力学、凝血功能、心功能均无明显影响,可安全用于腰椎手术。
Objective To evaluate the clinical effects of acute hypervolemic hemodilution （AHH） combined with controlled hypotension（CH） on patients undergoing lumbar surgery,observe its blood conservation effect and safety. Meth- ods 90 patients undergoing lumbar surgery were randomly divided into three groups with 30 patients each. Patients in group A were infused with Sodium lactate Ringer＇s solution （6 - 8） mL/kg. Patients in experimental group （n = 30） B were received Sodium lactate Ringer＇s solution （6 - 8） mL/kg and 6% HES 20 mL/kg in 30 minutes after anesthesia. Group C （n =30）were managed in the same way with group B,but induced artery blood pressure in a range of （65 -75） mmHg by Dexmedetomidine. In each group, when blood loss is greater than 20% of blood volume or Hct is lower than 25%, red cells is as appropriate . The HR, MAP,CVP,blood loss, blood transfusion and the time of operation were recor- ded. The Hb, Hct,PT, APTr and Fg were measured before of AHH, after AHH and at the end of operation. Results The blood loss in experimental group C were significantly lower compared with its in group A （ P 〈 0.01 ）. The Hct and Hb in experimental group on after AHH and at the end of operation were lower compared with those before AHH. The PT, APTr and Fg were increased in expenental group as compared to that before AHH. No lung edema,heart failure and abnormal bleeding occur in two groups. Conclusion AHH combined with dexmedetomidine controlled hypotension,can enhance the effect and improve microcirculation of blood, and decrease the amount of bleeding or even avoid allogeneic blood transfu- sion, and have no significant influence on the hemodynamics, coagulation function, heart function, can be safely used in lum- bar operation.
出处
《中国输血杂志》
CAS
CSCD
北大核心
2014年第2期174-176,共3页
Chinese Journal of Blood Transfusion
关键词
急性高容血液稀释
右美托咪定
控制性降压
腰椎手术
acute hypervolemic hemodilution
controlledhypotension
blood salvage
spinal surgery
作者简介
通信作者：艾登斌（1964．6-），男，主任医师，主要从事麻醉与临床输血研究，电话：0532-2789478，Email：ywr0824@sohu，com
