颅脑肿瘤手术应用急性等容血液稀释联合控制性降压对血流动力学及氧代谢的影响

Effects of acute normovolemic hemodilution combined with controlled hypotension on hemodynamics and oxygen metabolism during brain tumors operation

目的探讨颅脑肿瘤手术急性等容血液稀释(ANH)联合控制性降压(CH)对血流动力学和氧代谢的影响。方法选择2008～2009年该院收治的颅脑肿瘤手术患者60例随机分为两组:ANH联合CH组(A组)和单纯CH组(B组),每组30例。术中观察两组各设定时点的平均动脉压(MAP)、心率、中心静脉压(CVP)、心排血量、外周血管阻力(SVR)、乳酸(LAC)、血细胞比容(Hct)的变化,计算氧供、氧耗和氧摄取率(ERO2)。结果 MAP、心率、CVP、心排血量、SVR、LAC、Hct、氧供、氧耗和ERO2项目的不同时点比较差异有统计学意义(P<0.05)。结论术前ANH联合CH有助于颅脑肿瘤手术患者血流动力学的稳定,不影响机体氧代谢,且可有效减少术中用血。

Objective To study the effects of acute normovolemic hemodilution（ANH）combined with controlled hypotension（CH） on hemodynamics and oxygen metabolism during brain tumors operation.Methods Sixty patients adoped from 2008 to 2009 in our hospital were randomly divided into two groups：ANH combined CH group（group A,n=30）and pure CH group（group B,n=30）.The mean arterial pressure（MAP）,heart rate,central renous pressure（CVP）,cardiac output,systemic vascular resistance（SVR）,lactate（LAC）,hematocrit（Hct） were recorded on the set time point,and the oxygen delivery,consumption of orygen,and oxygen extraction ration（ERO2） were calculated.Results There were significant differences of MAP,heart rate,CVP,cardiac output,SVR,LAC,hematocrit（Hct）,oxygen delivery,consumption of orygen,and oxygen extraction ration（ERO2） at different time points between the two groups（P0.05）.Conclusion Preoperative ANH combined CH is helpful for the stable of hemodynamics in patients during brain tumors operation lohich,does not affect the body′s oxygen metabolism,and can reduce intraoperative blood transfusion effectively.