急性高容量血液稀释结合尼卡地平控制性降压对全髋翻修围术期血液动力学的影响

Effect of acute hypervolemic hemodilution combined with nicardipine controlled hypotension on hemodynamics in perioperation period of revision operation of total hip replacement

目的：观察急性高容量血液稀释（AHH）结合尼卡地平控制性降压对全髋翻修手术中患者血液动力学的影响。方法：全髋翻修手术患者40例分成两组，按手术先后顺序单数为A组，双数为B组：A组AHH结合尼卡地平控制降压组（20例）和B组为对照组（20例）。两组患者在诱导后切皮前实施AHH，A组快速输注6%羟乙基淀粉15mL·kg^-1、30mL·min^-1，同时用微量泵输注尼卡地平0．3～O．5mg·kg^-1·h^-1.MAP控制在60～65mmHg（1mmHg=0．133kPa）；B组输注等量生理盐水，观察记录术前、AHH后1h和术后24h时的心率（HR）、平均动脉压（MAP）、中心静脉压（CVP）、血红蛋白（Hb）、红细胞比容（Hct）、血小板（Pit）变化。结果：A组联合降压AHH后MAP显著低于术前（P〈O．01）和B组（P〈O．01），停止降压后略高于B组；HR两组无明显变化。AHH后两组CVP均明显升高（P〈O．01），A组低于B组（P〈O．05）。AHH后两组患者Hb、Hct、Pit均显著下降（P〈O．05或P〈0．01），术后24h上升，B组低于术前，但无统计学意义，但A组Hb低于术前（P〈O．05）。结论：在全髋翻修术中应用急性高容量血液稀释结合尼卡地平控制性降压能够维持围手术期血液动力学稳定。

Objective To observe the effect of acute hypervolemic hemodilution （AHH） combined with nicardipine controlled hypotension on hemodynamics changes in revision operation of total hip replacement. Methods Forty patients were divided into two groups according to the sequence of the surgery （odd number came into group A, even number came into group B, 20 in each group）. In group A, AHH was carried out with nicardipine controlled hypotension; group B was control group. AHH was carried out in both groups before anesthesia induction. 6% voluven was transfused in group A at 15 mL·kg^-1 and 30 mL·kg^-1 and nicardipine was transfused at 0.3- 0.5 mL·kg^-1·h^-1 with MAP altering between 60 and 65 mmHg; Same quantity of physiological saline was transfused in group B. HR, MAP, CVP, Hb, Hct and Plt were recorded and observed at preoperation, 1 h after AHH and 24 h after the operation. Results In group A after AHH with nicardipine controlled hypotension, MAP was obviously lower than pre-operation （P〈0. 01） and group B （P〈0. 01） and higher than group B when controlled hypotension ceased. There was no much variation in HR. There was an evident rise of CVP in both groups （P〈0. 01）, it was lower in group A than that in group B （P〈0. 05）. Hb, Hct and Plt decreased evidently after AHH （P〈0. 01, P〈0. 05） and went up 24 h post-operation, and there was no statistical significance when they went lower than preoperation in group B, while Hb in group A was still lower than that pre-operation （P〈0.05）. Conclusion AHH combined with nicardipine controlled hypotension can maintain stable hemodynamics in revision operation of total hip replacement.