摘要
目的:探讨急性高容量血液稀释(AHH)联合控制性降压(CH)对老年骨科手术患者血液流变学及凝血指标的影响。方法:选择老年骨科手术患者60例,ASA分级Ⅰ~Ⅱ级,随机分为A组和B组,每组30例。麻醉诱导后A组按15 ml/kg的量输注6%羟乙基淀粉130/0.4,总量控制在自身血容量的20%~25%,40~50min内完成,同时泵注硝酸甘油0.5~1.5μg·kg^(-1)·min^(-1)行CH,维持血压在基础值的20%以内。B组不实施AHH和CH。观察比较2组麻醉诱导后扩容前(T_0)、扩容后即刻(T_1)、扩容后30 min(T_2)、扩容后60 min(T_3)的收缩压(SBP)、舒张压(DBP)、心率(HR)、中心静脉压(CVP)、全血黏度高剪切率、全血黏度低剪切率、血浆黏度、血细胞比容、凝血酶原时间(PT_)、活化部分凝血活酶时间(APT_T_)、凝血酶时间(T_T_)等指标。结果:(1)与T_0时比较,2组T_1、T_2、T_3时SBP、DBP下降(P<0.05),与T_0时和B组比较,A组T_1、T_2、T_3时CVP升高(P<0.05),但均在正常范围内。2组间不同时间节点SBP、DBP、HR比较差异无统计学意义(P>0.05)。(2)A组T_1、T_2、T_3时全血黏度高剪切率、血细胞比容明显低于T_0时和B组(P<0.05),A组T_1、T_2、T_3时全血黏度低剪切率明显低于T_0时(P<0.05)。A组T_1、T_2、T_3时PT_较T_0时延长(P<0.05),但在正常范围内。(3)与B组比较,A组术中尿量增多,出血量、输血率及输血量减少(P<0.05)。结论:羟乙基淀粉AHH联合硝酸甘油CH对老年骨科手术患者的凝血功能影响较小,可明显改善患者的血液流变学,节约血液资源。
Objective：To explore the influence of acute hypervolemic hemodilution（AHH）combined with controlled hypotension（CH）on hemorheology and coagulation indexes in elderly patients with orthopaedic surgery.Method：A total of 60 elderly patients with orthopaedic surgery were chosen,ASA classⅠtoⅡ,and were divided randomly into group A（n=30）and group B（n=30）.Group A was infused 6% hydroxyethyl starch solution（HES）130/0.4,15 ml/kg at 20% to 25% of their own blood volume after anesthesia induction,40 to 50 min to finish,and received deliberate hypotension by pumping into glycerol trinitrate at 0.5 to 1.5μg·kg·min^（-1） simultaneously.Group A did not received AHH and CH.Systolic blood pressure（SBP）,diastolic blood pressure（DBP）,heart rate（HR）,central venous pressure（CVP）,high shear rate of whole blood viscosity,low shear rate of whole blood viscosity,plasma viscosity,packed cell volume,prothrombin time（PT）,acrivated partial thromboplasin time（APTT）,thrombin time（TT）after anesthesia induction and before AHH（T0）,immediate after AHH（T1）,30 min after AHH（T2）,60 min after AHH（T3）were observed and compared in two groups.Result：（1）Compared with T0,SBP and DBP at T1,T2,T3 decreased（P〈0.05）in two groups,compared with T0 and group B,CVP at T1,T2,T3 elevated（P〈0.05）in group A,but were within normal ranges.SBP,DBP,HR between two groups was no statistical different（P〉0.05）.（2）Compared with T0 and group B,high shear rate of whole blood viscosity,packed cell volume at T1,T2,T3 in group A were lower significantly（P〈0.05）.Low shear rate of whole blood viscosity at T1,T2,T3 in group A were lower significantly than T0（P〈0.05）.PT at T1,T2,T3 in group A were longer significantly than T0（P〈0.05）,but were within normal range.（3） Compared with those in group B,the urine output increased,the amount of bleeding,the ratio and amount of allogeneic blood transfusion decreased（P〈0.05）in group A.Conclusion：The infulence of AHH combined with CH on coagulation function of elderly patients with orthopaedic surgery is less,and can improve significantly the hemorheology indicators.
作者
赵顺来
解永强
李莉
龚亚娜
张艳杰
ZHAO Shunlai;XIE Yongqiang;LI Li;GONG Yana;ZHANG Yanjie(Bone Surgery, Fourth People＇s Hospital of Langfang City, Langfang, 065700, China;Hand＇Foot Surgery, Fourth People＇s Hospital of Langfang City;a Department of Ophthalmology, Fourth People＇s Hospital of Langfang Cit;First Division of Medical Department,Fourth People＇s Hospital of Langfang City;Clinical Laboratory,Bazhou Maternity and Child Care)
出处
《临床血液学杂志（输血与检验）》
CAS
2018年第2期264-267,共4页
Journal of Clinical Hematology(Blood Transfusion & Laboratory Medicine)
关键词
急性高容量血液稀释
控制性降压
血液流变学
凝血
acute hypervolemic hemodilution
controlled hypotension
hemorheologyl coagulation
作者简介
通信作者：解永强，E-mail：cdqiuhn@163．com
