急性高容量血液稀释复合异丙酚控制性降压用于脊柱手术的临床研究

A clinical study of acute hypervolemic hemodilution combined with propofol controlled hypertension on spine operation

目的探讨急性高容量血液稀释(AHH)复合异丙酚控制性降压对脊柱手术的临床效果及安全性。方法45例脊柱手术病人随机分为三组:组Ⅰ为对照组;组Ⅱ为AHH配合硝普钠控制性降压;组Ⅲ为AHH配合异丙酚控制性降压。术中持续监测生命体征,记录出血量,异体血输入量及手术时间,并分别于AHH前,AHH后10min,30min,术毕测定Hb,Hct,PLT;手术前,术后当天,术后7d测定凝血功能(PT、TT、APTT)。结果组Ⅱ、Ⅲ出血量,异体血输入量,手术时间明显少于组Ⅰ(P<0.05)。术中MAP、HR、CVP均在安全范围。组Ⅱ,组Ⅲ的Hb,Hct各时段始终低于AHH前,但在正常范围。手术前后凝血功能无显著变化。结论AHH配合异丙酚控制性降压可安全用于脊柱手术,可明显减少甚至避免输注异体血。

Objective To evaluate the effects and safeties of acute hypervolemic hemodilution (AHH) combined with propofol controlled hypertension on spine operation. Methods Forty-five patients undergoing spine operation were randomly divided into three groups: Group one (control gruop), Group two (nitroprusside group), Group three (propofol group). MAP,SpO_2 and CVP were monitored always.The volume of intraoperative blood loss ,amount of allogenic blood transfused and the duration of operation were also recorded.Hb,Hct and PLT were detected before AHH; 10min,30min after AHH and after operation.Blood coagualtion (PT,TT,APTT)were detected before operation,the day and 7d after operation. Results The volume of intraoperative blood loss,amount of allogeneic blood transfused and the duration of operation in group two and three were significantly less than that in group one.MAP,HR and CVP showed no significant change during operation.Hb and Hct in group two and group three were lower than those before AHH. Blood coagulation was not prolonged before and after operation. Conclusion AHH combined with propofol controlled hypertension is safe on spine operation,leading to less blood loss and allogeneic blood transfused.