急性高容量血液稀释复合控制性降压用于颅脑肿瘤手术

Effect of Acute Hypervolemic Hemodilution Combined with Controlled Hypotension on Hemodynamics in the Intracranial Tumor Surgery

目的 观察急性高容量血液稀释 (AHH)联合应用控制性降压 (CH )对颅脑肿瘤手术病人血流动力学的影响及对节约用血的评估。 方法 ASA ～ 级的颅脑手术病人 2 4例随机分为 AHH +CH组 (A组 ,n=1 2 )和单纯 AHH组 (B组 ,n=1 2 )。两组病人术前血红蛋白 (Hb)和红细胞压积 (Hct)均 >1 1 0 g/ L和 35 %。两组用 6 %羟已基淀粉 (1 5 m L / kg)在麻醉后至硬脑膜打开之前进行血液稀释 ,A组在硬脑膜打开后复合应用硝酸甘油 (0 .5μg· kg- 1 · min- 1 )降压 ,B组未用控制性降压。观察两组 AHH前后平均动脉压 (MAP)、心率 (HR)、中心静脉压(CVP)、尿量变化、失血量和输血量。 结果 两组在 AHH后 MAP、HR均无明显变化 (P>0 .0 5 ) ,CVP均比 AHH前升高 (P<0 .0 5 ) ,但仍在正常范围。 A组在应用硝酸甘油后 CVP下降 (P<0 .0 5 ) ,A组失血量明显小于 B组 (P<0 .0 5 )。 结论 在颅脑肿瘤手术病人 ,实施 AHH(6 %羟已基淀粉 1 5 m L / kg)进行高容量血液稀释能保持血流动力学稳定 。

Objective To assess the effect of acute hypervolemic hemodilution(AHH) combined with controlled hypotension(CH) on hemodynamics and reducing blood transfusion in intracranial tumor surgery. Methods Twenty four ASA Ⅰ Ⅱ patients with intracranial tumor scheduled for intracranial surgery were randomly divided into AHH with CH group(A, n=12) and AHH alone group(B, n=12). The patients' Hb was more than 110 g/L and Hct more than 35%. AHH was carried out by intravenous infusion of hydroxyethyl starch(15 mL·kg -1 ) started from the beginning of anesthesia to the opening of dura in both groups. Controlled hypotension was performed after the opening of dura by continues iv infusion of nitroglycerin(0.5~1 μg·kg -1 ·min -1 ) in group A. MAP, HR, CVP and urine fluids were monitored before AHH and after AHH. Blood losses and blood transfusion during operation were recorded. Results There was no significant change in MAP, HR after AHH(P>0 05) and CVP increased significantly after AHH(P<0 05) in both groups as compared with those before AHH. CVP was decreased significantly after using nitraglycerin(P<0 05) in group B. Blood losses in group A was decreased than the group B obviously. Conclusion Hemodymamics can be fairly well maintained during AHH in intracranial surgery and blood losses decreased when AHH combined with controlled hypotension.