摘要
目的:探索以每搏量变异度(stroke volume variation,SVV)为目标导向行急性超容血液稀释(acute hypervolemic hemodilution,AHHD)在脊柱肿瘤手术中减少失血量和输血量的有效性和安全性。方法:选取2020年1月至2021年10月于四川省医学科学院·四川省人民医院收治的脊柱肿瘤患者40例,随机分为A组和B组,每组20例。A组行AHHD术中保持SVV≤7%,B组行AHHD术中保持SVV≥13%。记录血液稀释前(T0)、血液稀释后(T1)、出血500 mL时(T2)、出血1000 mL时(T3)、手术结束后30 min(T4)各时间节点血气分析结果各时间点血气分析结果,局部脑氧饱和度(regional cerebral oxygen saturation,rSO_(2))以及血流动力学指标;术前1 d、术后1、3、5 d采用MMSE评分。结果:术中两组间失血量差异无统计学意义(P>0.05);术中A组总输液量、尿量分别多于B组,输血量、输血率较B组明显降低(P<0.05)。与A组比较,B组患者T3时间点HR增加、MAP下降、Lac升高、rSO_(2)降低(P<0.05);B组术后1 d的MMSE评分较A组降低,认知功能障碍发生率高于A组(P<0.05)。结论:SVV≤7%目标导向行AHHD能减少脊柱肿瘤手术中的输血量和输血率,血流动力学更稳定,降低术后认知功能障碍的发生率。
Objective:To assess the efficacy and safety of acute hypervolemic hemodilution(AHHD)targeting stroke volume variability(SVV)in reducing blood loss and transfusion volume in patients who underwent spinal tumor surgery.Methods:Forty patients with spinal tumor enrolled in Sichuan Academy of Medical Sciences&Sichuan Provincial People’s Hospital from January 2020 to October 2021 were randomly categorized into groups A and B,20 cases each.Patients in group A received AHHD with SVV≤7%,and those in group B received AHHD with SVV≥13%.Blood gas analysis results,regional cerebral oxygen saturation(rSO_(2))levels,and hemodynamic indexes at before AHHD(T0),after AHHD(T1),bleeding 500 mL(T2),bleeding 1000 mL(T3),and 30 min after the surgery(T4)were recorded.The mini-mental state examination(MMSE)scores on the day before surgery and on days 1,3,and 5 postoperatively were recorded.Results:There was no significant difference in blood loss volume between both the groups(P>0.05).During surgery,total infusion volume and urine volume were higher in group A than in group B,and blood transfusion volume and rate were lower in group A than in group B(P<0.05).Compared with group A,the heart rate(HR)and lactate level increased and mean arterial pressure(MAP)and rSO_(2)decreased in group B at T3(P<0.05).The MMSE scores on day 1 postoperatively were lower in group B than in group A,and the incidence of cognitive dysfunction was higher in group B than in group A(P<0.05).Conclusions:Target-oriented AHHD with SVV≤7%can decrease the blood transfusion volume and rate during spinal tumor surgery,stabilize hemodynamics,and reduce the incidence of postoperative cognitive dysfunction.
作者
徐广民
蔡兵
苏鹏
刘书婷
李美婷
杨丽娜
Guangmin Xu;Bing Cai;Peng Su;Shuting Liu;Meiting Li;Lina Yang(Department of Anesthesia,Sichuan Academy of Medical Sciences&Sichuan Provincial People’s Hospital,Chengdu 610072,China)
出处
《中国肿瘤临床》
CAS
CSCD
北大核心
2022年第15期781-785,共5页
Chinese Journal of Clinical Oncology
基金
四川省科技计划项目(编号:2020YFS0418)资助。
关键词
每搏量变异度
急性超容血液稀释
血流动力学
出血
局部脑氧饱和度
stroke volume variation(SVV)
acute hypervolemic hemodilution(AHHD)
hemodynamics
hemorrhage
regional cerebral oxygen saturation(rSO2)
作者简介
徐广民,专业方向为临床麻醉及围术期器官保护诊疗研究。E-mail:xgmin2004@163.com;通信作者:杨丽娜,605033376@qq.com。
