硝酸甘油控制性降压在老年患者急性高容量血液稀释中的应用

Application of acute hypervolemic hemodilution combined with Nitroglycerin controlled hypotension in the elderly patients

目的观察硝酸甘油应用于老年患者急性高容量血液稀释的可行性。方法选择择期手术老年患者30例。随机分为应用急性高容量血液稀释组(Ⅰ组)、急性高容量血液稀释联合应用硝酸甘油控制降压组(Ⅱ组)和对照组(Ⅲ组)。比较3组患者麻醉前(T0)、切皮前(T1)、手术主要步骤结束后(T2)、术后24h后(T3)血流动力学指标、凝血指标、术中尿量、总出血量及异体血输入例数。结果Ⅰ、Ⅲ组患者CVP值在血液稀释后(T1、T2)较基础值(T0)均明显升高(P<0.05),Ⅱ组患者CVP值则无明显变化;Ⅱ、Ⅰ组的术中实际出血量明显低于Ⅲ组(P<0.05)。Ⅱ组患者无术中输血,显著低于Ⅰ组(P<0.05),显著低于Ⅲ组(P<0.01)。Ⅰ、Ⅱ组患者与Ⅲ组比较,血小板数和纤维蛋白原明显减少(P<0.05),而PT、APTT则明显延长(P<0.05),但均在正常范围内。结论联合应用硝酸甘油控制性降压不仅能明显加强急性高容量血液稀释的血液保护效果,还能减少容量负荷过重对机体的不利影响,对老年患者有心肌保护的优势,是安全有效的血液保护措施,值得推广应用。

[Objective] To explore the possibility of acute hypervolemie hemodilution combined with controlled hypotension with Nitroglycerin in the elderly patients. [Method] 30 elderly patients are randomly divided into three groups. Group Ⅰ （n =10）received acute hypervolemic hemodilution alone, Group Ⅱ （n =10） received acute hyperv- olemie hemodilution combined with controlled hypotension with Nitroglycerin. Group Ⅲ （n =10） is controlled group. Inspected and memorized the following index： 1）the figures of blood clotting function and blood routine 2） the vol- ume of urine,blood loss and blood- transfusion before anaesthesia （TO）, skin incision （T1）, fundamental procedure of the operations（T2）, postoperative 24 hours（T3）. [Result] Group I and Group Ⅲ patients CVP value of the blood dilution （T1, T2） than baseline （TO） were significantly increased （P 〈0.05）, Group Ⅱpatients CVP value had no siguif- ieant changes. Group Ⅰ and Group Ⅱ in the actual amount of bleeding significantly lower than Group HI （P 〈 0.05）. Group Ⅱ patients without intraoperative blood transfusion, significantly lower than that in group Ⅰ （PP 〈0.05）, siguifieantly lower than that in Group Ⅲ （P 〈0.01）. Group Ⅰ , Group II and Group Ⅲ patients, the platelet count and ftbrinogen significantly reduced （P 〈0.05）, while PT, APTT was significantly longer （P 〈0.05）, but were within the normal range. [Conclusion] Acute hypervolemie hemodilution combined with Nitroglycerin controlled hypoten- sion can enhance the effect of blood conservation ,especially Nitroglycerin can lessen volume load and possess better myocardial preservation.