急性高容量血液稀释在腰硬联合麻醉下骨科手术中的应用

The application of acute high-capacity hemodilution to bone surgery under combined spinal-epidural anesthesia

目的观察使用6％中分子羟乙基淀粉（voluven，130／0．4）对腰硬联合麻醉下骨科手术行急性高容量血液稀释（AHH）的可行性。方法选择预计出血量大于600ml的骨科手术32例，ASAⅠ～Ⅱ，所有患者术前Hb〉110异／L，红细胞压积（HCT）〉35％。32例患者随机分为两组：实验组（A组，／7,=16）和对照组（B组，n=16），A组：腰麻后开始血液稀释，快速输入6％中分子羟乙基淀粉（Volume，130／0．4）15ml／kg，速率30ml／min，在手术开始前完成。B组：常规输液。结果A组血液稀释后中心静脉压（CVP）显著增高（P〈0．01），但在正常范围内，A组HCT、Hb在T1、T2分别低于B组（P〈0．05），T3两组比较差异无统计学意义，A组稀释后HCT、Hb与术毕比较差异无统计学意义（P〉0．05），A组RS各时点比较差异无统计学意义，B组T1、T2、T3与T0相比明显升高（P〈0．05）；A组术中输液量及尿量高于B组（P〈0．05），B组术中输血量高于A组（P〈0．05）。结论使用6％中分子羟乙基淀粉（万汶，130／0．4）行AHH可有效地减少异体血的输注；并能抑制围术期血糖水平应激性增高，有利于患者术后恢复。在腰硬联合麻醉下骨科手术行AHH是安全方便、切实可行的。

Objective To investigate the feasibility of the use of 6% molecular hydroxyethyl starch （voluven, 130/0. 4） to the application of acute high-capacity hemodilution （AHH） to bone surgery under combined spinal-epidural anesthesia. Methods 32 cases of orthopaedic surgery. ASA Ⅰ - Ⅱ, expected amounat of bleeding more than 600 ml, were selected and the preoperative Hb and HCT of all cases were respectively more the 110 g/L and 35%. 32 cases were randomly divided into two groups： experimental group （group A, n = 16） and control group （ group B, n = 16） . Group A started hemodilution after spinal anesthesia, inputing 6% molecular hydroxyethyl starch （ voluven, 130/0. 4） 15 mg/kg rapidly till the start of operation. Group B were given conventional infusion. Results CVP after hemodilution in Group A increased significantly （P 〈 0.01 ）, but in the normal range ; HCT. Hb in T1 and T2 in Group A were respectivly lower than in group B （ P 〈 0. 05 ） and there were no differences in T3 between the two groups; there were no differences between HCT or Hb after dilution and that after operation （P 〉0. 05 ） ; there were no diffferences among the de factos of RS in Group A, but T1, T2, T3 increased significantly compared with To in Group B （ P 〈 0. 05 ） ; infusion volume and urine in Group A were higher than in Group B （ P 〈 0. 05 ）, blood transfusion volume in Group B was higher than in Group A （ P 〈 0. 05 ） . Conclusion AHH using 6% molecular hydroxyethyl starch （voluven, 130/0. 4） may be effective in reducing allogeneic blood transfusion, and can inhibit stress increasing of perioperative blood glucose level. It is feasible to apply AHH in bone surgery under combined spinal-epidural anesthesia.