控制性降压联合急性高容血液稀释对巨大垂体瘤手术的意义

Clinical Significance of Deliberated Hypotension Combined with Acute Hypervolemic Hemodilution on Huge Pituitary Tumor Surgery

目的观察控制性降压结合急性高容血液稀释(AHH)对垂体瘤手术的安全性及减少出血量和术后血红蛋白(Hb)、红细胞比积(Hct)的影响。方法择期垂体瘤手术病人30例,随机分成控制性降压结合AHH组(Ⅰ组,n=15)和对照组(Ⅱ组,n=15),两组均采用气管内全麻。Ⅰ组病人于气管插管后手术开始前完成AHH并进行控制性降压。比较两组病人术中出血量、输血量和术后Hb、Hct变化。结果Ⅰ组病人术中平均出血量(635±92)m l,Ⅱ术中平均出血量(1 172±182)m l;Ⅱ组病人平均输血量(650±112)m l,Ⅰ组病人则完全避免输异体血。两组病人术毕均有轻度贫血,但仍在安全水平范围内。结论控制性降压结合急性高容血液稀释可安全应用于垂体瘤手术,对有指征病人的使用可避免术中输异体血。

Objective To observe the effects of deliberated hypotension combined with acute hypervolemic hemodilution（AHH）on blood loss,postoperative hemoglobin（Hb）,hematocrit（Hct） and safety of the patients undergoing huge pituitary tumor operation.Methods Thirty patients undergoing selectively huge pituitary tumor operation were randomly divided into two groups ： hypotensive group（n=15） and control group（n=15）,all patients were anesthetized with endotracheal intubation anesthesia.Intraoperative blood loss,blood transfused volume during operation,postoperative hemoglobin（Hb） and hematocrit（Hct） were recorded and compared between the both groups.Results The average volume of bleeding during operation was（635±92）ml,（1172±182）ml in the group one and group two respectively,The average volume of transfused blood during operation was（620 ±112）ml,however blood transfusion was avoided in the hypotension group.The patients had a mild anemia postoperatively in both groups,which was still within safe limits.Conclusion Deliberated hypotension combined with AHH is safe for patients undergoing huge pituitary tumor operation and can significantly decrease the intraoperative blood loss and can be well tolerated for the indicated patients.