高容量血液稀释结合控制性降压用于肺手术的观察

A study of the application of deliberated hypotension combined with acute hypervolemic hemodilution during lung surgery

目的评价术前急性高容量血液稀释(AHH)应用于肺手术中节约用血的安全性。方法40例ASAⅠ～Ⅱ级毁损肺行肺叶切除手术病人,随机均分为观察组(H组)和对照组(R组)。H组,常规输入复方乳酸钠的同时于切皮前输入6%羟乙基淀粉(6%HES,15ml/kg);R组,仅常规输入复方乳酸钠。两组均采用异氟醚吸入麻醉。术中用硝普钠控制性降压,持续监测MAP、HR、CVP,分别于稀释前、稀释后、术毕测血小板计数(Plt)、凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、乳酸(Lac);记录术中输液量、输血量,并计算出血量。结果H组与R组MAP和HR平稳;H组CVP和PT稀释后明显升高和延长,Plt明显减少(P<0.05),但在正常范围内;APTT、Lac浓度组间比较差异无显著意义(P>0.05);术毕两组输液量和出血量差异无显著意义(P>0.05);H组输血量明显低于对照组(P<0.05)。两组胸腔负压引流瓶引流总量及引流管拔除时间差异无显著意义(P>0.05)。结论采用6%HES行AHH能安全应用于肺科手术,血液动力学维持稳定,可有效地提高机体对失血的耐受性,明显减少异体输血量。

Objective To evaluate the safety of the application of deliberated hypotension combined with acute hypervolemic hemodilution during lung operation. Methods Forty ASA Ⅰ-Ⅱ patients with destructive pneumonophthisis undergoing lobectory were randomized to two groups. The same account of lactated Ringer＇s solution was infused and isoflurane inhaled during operation in the patients of two groups. In AHH group, 6%HES （200/0.5, 15 mg/kg） was infused before incision. MAP, HR,CVP, Her were monitored. Pit, PT, APTT and Lac were measured before and after hemodilution, at the end of operation. The volume of infusion, blood loss and blood transfusion were recorded. Results Following hemodilution in AHH group, CVP and PT changed markedly （P 〈0. 05）,but were still in the normal range. The required volume of lactated Ringer＇s solation and blood loss of two groups was similar. But blood transfusion was significantly less in AHH group than that in the control （P〈0.05）. Conclusion 6%HES 200/0.5 can be used safely for AHH, and effectively reduce the blood transfusion.