急性高容量血液稀释用于小儿脊柱侧弯手术的临床观察

Clinical observation of acute hypervolemic hemodilution in scoliosis surgery on children

目的探讨急性高容量血液稀释（AHH）技术用于小儿脊柱侧弯后路融合术的临床效果与安全性。方法36例择期行脊柱侧弯后路融合术的患儿随机分为AHH组（n=18）和对照组（CNT组，n=18）。AHH组麻醉诱导后从颈内静脉输注万汶予以预扩容；CNT组常规补液，不进行额外扩容。术中当Hb〈80g／L或Hct〈25％时输入同型异体红细胞，保持Hct不低于25％。结果两组术中估计失血量差异无统计学意义。AHH组和CNT组术毕Hb[AHH组：（98±10）g／L；CNT组：（94±13）g／L]和术后第1天[AHH组：（89±12）g/L；CNT组：（92±22]g／L]都较术前下降（P〈0．05），但两组间差异无统计学意义（P〉0．05）。AHH组术中输入同型异体红细胞（18±4）ml／kg，冷冻血浆（3．5±1．1）ml／kg，均少于CNT组[RBC：（28±11）ml／kg；FFP：（5．8±1．8）ml／kg]，差异有统计学意义（P〈0．05）。结论急性高容量血液稀释技术在小儿脊柱侧弯后路融合术中具有很高的运用价值，可节约用血，减少医疗费用。

Objective To evaluate the clinical efficacy and safety of acute hypervolemic hemodilution （AHH） in posterior spinal fusion surgery in children. Methods 36 children with scoliosis ASA Ⅰ- Ⅱ, receive of posterior spinal fusion, were randomly divided into 2 equal groups： AHH group, transfused with hydroxyethyl starch 130/0.4 and sodium chloride（Voluven） 12 ml/kg at the speed of 0.3 - 0.4 ml ·kg^-1·min^-1 （for 30～40 min） through internal jugular vein before operation so as to keep the hemodilution （Hb） status during operation, and control （CNT） group. During operation when the Hb was 〈80 g/L or the hematocrit was 〈 25% blood transfusion was conducted to maintain the Hct〉 25%. Results There was no significant difference in intra-operative blood loss between these 2 groups. The Hb one day after operation of the AHH group was （89 ± 12） g/L, significantly lower than that immediately after operation [ （98 ±10） g/L, P 〈 0.05 ]. The Hb one day after operation of the CNT group was （92± 22 ） g/ L, significantly lower than that immediately after operation [ （94 ± 13） g/L, P 〈 0.05 ]. However, there were not significant differences in the Hb values between the AHH and CNT groups （ all P 〉 0.05 ）. Both groups received intra-operative transfusion during operation. The amount of transfused red blood cells and fresh frozen plasma of the AHH group were （ 18 ±4） mg/kg and （3.5 ± 1.1 ） ml/kg respectively, both significantly lower than those of the CNT group [ （ 28± 11 ） and （ 5.8 ± 1.8 ） ml/kg respectively, both P 〈 0.051. Conclusion Able to reduce intra-operative blood transfusion and medical expense, AHH can be used safely and effectively in posterior spine fusion in children.