急性高容性血液稀释联合控制性降压用于腹膜后肿瘤中的探讨

目的探讨急性高容性血液稀释(AHH)联合控制性降压(CH)技术对腹膜后肿瘤手术的影响。方法选择腹膜后肿瘤病例38例随机分为两组,A组(不进行AHH及CH);B组(6%羟乙基淀粉行AHH联合乌拉地尔行CH),每组19例。观察记录T0(麻醉前,基础值)、T1(AHH联合CH的应用后30min)、T2(术毕)的MAP、HR、SpO2、pH、PaCO2、Hct、Hb及APTT、PT、FIB的数值变化,并总结失血例数、失血量及输血量。结果 T1时点B组与基础值及A组比较MAP、Hct、Hb均明显下降,PT明显升高;T2时点A组和B组Hct、Hb均下降,B组下降的更明显,B组PT较基础值及A组升高。B组较A组失血量、失血例数及输血量明显减少。结论急性高容性血液稀释联合控制性降压技术用于腹膜后肿瘤患者在一定时间内对血液参数有影响,但均在在可控范围内,且可明显减少术中出血量。

Objective To investigate the effect of acute hypervolemic hemodilution combined with controlled hypotension on retroperitoneal tumor surgery.Methods Thirty-eight patients undergoing elective retroperitoneal tumor surgery were enrolled randomized into two groups with 19 cases each,group A（not to AHH and CH）,group B（to AHH by 6% hydroxyethyl starch and CH by Urapidil）.MAP,HR,SpO2,pH,PaCO2,Hct,Hb and APTT,PT,FIB were measured at different time points of T0（Baseline）,T1（30 minutes after the application of AHH and CH）,T2（The end of surgery）,And summarized the number of cases of blood loss,blood loss and blood transfusion.Results MAP,Hct,Hb had a signifi cantly decreased and PT had a signifi cantly increase in T1 in the group B compared with the baseline T0 and the group A（P0.05）,Hct,Hb had a signifi cantly decreased in T2 in the group A and group B（P0.05）,group B is more evident（P0.05）,PT had a signifi cantly increase in the group B compared with the baseline T0 and the group A（P0.05）.blood loss,number of cases of blood loss,transfusion had a signifi cantly decreased in group B than group A.Conclusion Acute hypervolemic hemodilution combined with controlled hypotension technology for patients with retroperitoneal tumors affect the blood parameters within a certain period of time,but all in the context of the control,and can be signifi cantly reduced blood loss.