急性高容血液稀释联合控制性降压在骨科手术中应用的观察

Application of acute hypervolemic hemodilution combined with controlled hypotension in patients undergoing orthopedic operation

目的观察急性高容量血液稀释(AHH)联合控制性降压(CH)对骨科手术患者血液动力学、氧代谢的影响。方法择期骨科手术患者48例,ASAⅠ～Ⅱ级,随机分为2组,每组24例:A组为对照组;B组为AHH联合CH组。两组患者均采用全身麻醉,术中连续监测平均动脉压(MAP)、中心静脉压(CVP)、心率(HR)、心电图(ECG)、脉搏血氧饱和度(SPO2)和尿量。分别于稀释前插管后(T0)、稀释后即刻(T1)、稀释后1h(T2)、术毕(T3)测定血红蛋白(Hb)、红细胞压积(Hct)、乳酸、动脉血氧含量(CaO2)及凝血指标等变化,并计算氧摄取率(ERO2),术中记录输血量、输液量和失血量。结果与A组比较,B组术中失血量、平均输血量以及输血例数减少(P<0.01),尿量增多(P<0.01)。与T0比较,B组AHH后CVP升高(P<0.01);两组AHH后Hb、Hct、CaO2均明显下降(P<0.01),但两组间同期比较差异无显著性意义。两组ERO2、乳酸各时点及组间比较变化无显著性差异(P>0.05)。B组PLT、FIB在AHH后、术毕均显著降低(P<0.01),但两组间差异无显著性意义。两组患者其他凝血机能指标(PT、TT、APTT)手术前后均无明显变化。结论术前急性高容量血液稀释联合控制性降压能较好维持骨科手术患者机体血液动力学和氧代谢的相对稳定,显著减少出血量和异体输血。

Objective To investigate the effects of acute hypervolemic hemodilution（AHH） combined with hypotension （CH） on hemodynamics and tissue perfusion in patients undergoing orthopedic operation. Methods Forty eight ASA Ⅰ - Ⅱ patients undergoing orthopedic operation were randomly divided into 2 group with 24 patients in each ：group A（control group）and group B （CH＋AHH group）. ECG,MAP,HR,CVP,SPO2 and urine output were continuously monitored during operation.Blood samples were taken from radial artery and right atrium before AHH （To baseline）, immediately after AHH （T,）, lh after AHH （T2）,at the end of surgery （T3） for blood gas analysis and calculation oxygen extraction ratio （ERO2）. The amount of blood loss and blood transfusion were recorded.Results The blood loss and the ratio of homologous packed RBC transfused in group B were significantly less than that in group A （P〈0.01）.Urine output was increased in group B compared with group A （P〈0.01）. CVP increased significantly after AHH in group B as compared to baseline（P〈0.01）. Hct, Hb and ERO2 decreased significantly after AHH as compared to the value at To in two groups（P〈0.01）,but there were no significant difference in these value between the two groups.PLT and FIB decreased significantly after AHH and surgery in group B, but there were no significant difference between the two groups. Conclusion AHH combined with CH decrease blood loss and blood transfusion during operation and maintain stable hemodynamics.