急性等容血液稀释复合控制性降压在颅脑手术中的应用评价

Evaluation of Actue Normovolemic Hemodilution Combined with Controlled Hypotension in Intracranial Operation

目的：评价急性等容血液稀释复合控制性降压在颅脑手术中应用的可行性。方法：选择加例ASAⅠ-Ⅱ级的择期颅内占位切除术患者，随机分成急性等容血液稀释复合控制性降压（Ⅰ）组和常规手术（Ⅱ）组。Ⅰ组在输入质量分数6％的中分子羟乙基淀粉500mL的同时，在右正中静脉采血（10—12）mL/kg，手术开始时用硝普钠控制BP，将平均动脉压控制在7．5—8．5kPa，在缝合硬脑膜时将自体血回输入患者体内。Ⅱ组在手术过程中有输血指征时（出血量〉血容量15％），输入浓缩RBC。结果：Ⅰ组乎均出血量明显少于Ⅱ组（P〈0．01），术毕两组血红蛋白明显低于术前（P〈0．01），但两组围手术期元贫血。Ⅰ组只有1例输注异体血，而Ⅱ组90％以上输注异体血。两组术后恢复良好，元嗜睡、恶心、呕吐、R减慢、BP升高等颅高压症状。结论：急性等容血液稀释复合控制性降压可减少颅内占位切除术患者术中出血量，达到术中少出血，少输异体血的目的，且操作简便，易于普及，值得推广。

Objective： To evaluate the feasibility of actue normovolemic hemodilution combined with controlled hypotension in meningioma surgery. Methods： Forty ASA Ⅰ - Ⅱ scheduled intracranial surgical patients were randomly divided into group Ⅰ（actue normovolemic hemodilution combined with controlled hypotension）and group Ⅱ（routine operation group）. Group Ⅰ received Haes（6%）500 mL while（ 10-12）mL/kg blood were collected from the arm venous. Nitropmsside sodium was used for controlled hypotension from the beginning of the operation, the mean arterial pressure was maintained within 7.5-8.5 kPa. The autologous blood was transfused back to the patients at the end of operation. In group Ⅱ, RBC were transfused when the blood lose more than 15% of blood valume. Results： Blood loses in group Ⅰ was significant less than in group Ⅱ （ P 〈 0.01 ）. Hemoglobin in both group at the end of operation was marked lower than preoperative value（ P 〈 0.01 ）, but there was no anemia in both groups. One patient in group Ⅰrequired heterologous blood transfusion, whereas 90% patients in group Ⅱ required heterologous blood transfusion. Both groups had good postoperative recovery. There were no symptoms of high intracranial pressure such as drawsiness, nanse, vomiting, bradycardia, hypertension. Conclusion： Actue normovolemic combined with controlled hypotension can reduce the blood lose and heterologous blood transfusion in maningioma patients undergoing intracranial operation. This technique is simple and easily wide used.