老年患者急性高容量血液稀释配合控制性降压的可行性研究

A Study of the Feasibility of Acute Hypervolemic Hemodilution Combined with Controlled Hypotension Hypotension in the Elderly Patients

目的评价围术期急性高容量血液稀释(AHH)配合控制性降压(CH)应用于老年患者的可行性。方法40例ASAI～Ⅱ级的全髋置换术老年病人随机分为AHH联合CH组(Ⅰ)和对照组(Ⅱ)各20例。术中监测MAP、CVP、HR、SPO2,分别在术前、AHH后1h和术后24h抽血测定Hb、Hct、Plt,记录术中出血量、输液量、输血量和尿量。结果Ⅰ组MAP显著低于术前(P<0.01)和Ⅱ组(P<0.01),两组CVP均明显升高(P<0.01),Ⅰ组低于Ⅱ组(P<0.01),两组HR无明显变化,Hb、Hct、Plt均显著下降(P<0.005～0.01),仍在正常范围内。Ⅰ组出血量明显少于Ⅱ组(P<0.05)。结论AHH联合CH可安全地应用于一般情况良好,无心肺疾患的老年患者,并有效的减少出血量。

Objective To evaluate the feasibility of acute hypervolemic hemodilution(AHH)combined with controlled hgpotension(CH)in the elderly patients during operation.Methods Forty ASA Ⅰ~Ⅱ elderly patients undergoing total-hip-replacement operation were randomized to AHH plus CH group(group Ⅰ)and control group(group Ⅱ),each group containing 20 patients.MAP,CVP,HR,and SPO2 were monitored during operation.Hb.Hct and Plt were also monitored before operation,1h after AHH and 24h after operation.The volume of blood loss,infusion,blood transfusion and urine were recorded during operation.Results MAP after operation in group Ⅰ was significantly lower than that before operation in groups Ⅰ and Ⅱ(P<0.01).CVP in the both groups obviously elevated,and CVP in the groupⅠwas significantly lower than that in groupⅡ(P<0.01),HR was comparable between the two groups.Hb,Hct and Plt significantly decreased after operation,but were still with normal range.The volume of blood loss in groupⅠwas less than that in groupⅡ(P<0.05).Conclusion AHH combined with CH can safely be applied to the elderly patients without cardiac and pulmonary disease,and effectively decreased the volume of blood loss.