控制性低血压复合高容量血液稀释在颅颌面外科手术中的应用

Deliberate hypotension combined with hypervolemic hemodilution used in craniomaxillofacial surgery

目的 :控制性低血压复合血液稀释技术已经广泛应用于外科手术进行血液保护。本文旨在评价控制性低血压复合高容量血液稀释在颅颌面外科手术中应用进行血液保护的临床效果。方法 :3例行颅颌面外科手术小儿 ,术中采用控制性低血压复合高容量血液稀释的麻醉方法 ,血液稀释采用快速输液使红细胞压积保持在2 0 %～ 30 %的水平 ,控制性低血压采用硝普钠或异氟醚维持平均动脉压在 5 0mmHg～ 6 0mmHg的水平。通过红细胞压积测定、失血量统计判断血液保护效果。结果 :控制性低血压复合高容量血液稀释的技术可减少手术失血 80 %以上 ;有效减少库血输入 ;为颌面外科手术创造透明清晰的手术野。结论 :控制性低血压复合高容量血液稀释可安全应用在颅颌面外科手术中 。

Objective:Deliberate hypotension combined with hypervolemic hemodilution is being widely used for blood conservation in surgical patients.The purpose of this study was to investigate the efficacy and safety of deliberate hypotension combined with profound hemodilution in the craniomaxillofacial surgery.Methods:Three children were performed deliberate hypotension combined with profound hemodilution in the craniomaxillofacial surgery.Deliberate hypotension was induced with nitroprusside or isoflurane to maintain mean arterial pressure at 50 mmHg～65 mmHg.Hypervolemic hemodilution was produced by preoperative infusion of lactated Ringer's Solution and Gelofusine,intraoperative hematocrit values were 20～30%.Blood loss and transfusion requirements were measured.Results:Blood loss was decreased over 80%, banked blood transfusion was reduced effectively,operation field was clear.Conclusion:It is safe to perform delibarate hypotension combined with hypervolemic hemodilution and this technique can provide effective blood conservation in the craniomaxillofacial surgery.