血液稀释联合氨甲环酸在神经外科手术中的应用

Application of hemodilution combined with tranexamic acid in neurosurgical operation

目的探讨急性高容量血液稀释（AHH）联合氨甲环酸（TA）在神经外科手术中使用的安全性和有效性。方法将40例择期行神经外科手术患者，采用随机数字表法分为试验组和对照组，每组20例。两组全身麻醉后均输入6％羟乙基淀粉（130／0．4）20ml／kg做AHH，试验组将TA静脉注入负荷量10mg／kg，以1mg／（kg·h）持续静脉输注直至手术结束；对照组仅做AHH。测定两组AHH前（T0）、AHH完成即刻（T1）、AHH后1h（R）、手术结束时（T3）的平均动脉压（MAP）、中心静脉胝（CVP）、心率（HR）、脉搏血氧饱和度（SpO2）。并在对应各时点采静脉血测定血红蛋白（Hb）、红细胞压积（Hct）和凝血酶原时间（PT）、活化部分凝血活酶时间（APTT）、血小板计数（Plt）、纤维蛋白原（FIB）。统计两组术中出血量、输血量和输血率。结果两组患者HR、MAP组内各时点及组间比较差异无统计学意义（P〉0．05），T1、T2时点CVP显著高于T0时点（P〈0．05），T1、T2、T3时点Hb、Hct均显著低于T0时点（P〈0．05）。对照组T2、T3时点PT、APTT明显长于T0时点（P〈0．05）；两组T1、T2、T3时点Plt均显著低于T0时点（P〈0．05），对照组Plt在T2、T3时点较试验组降低更显著（P〈0．01）；对照组FIB在T2、T3时点显著低于T0时点（P〈0．05）。试验组术中出血量、输血量、输血率分别为（650±560）ml、（150±50）ml、30％（6／20），明显低于对照组的（820±410）ml、（380±290）ml、60％（12／20），差异均有统计学意义（P〈0．05）。结论AHH联合TA静脉输注应用于神经外科手术，患者血流动力学稳定，对凝血功能影响小，有明显的节约用血效应。

Objective To study the safety and effectiveness of acute hypervolemic hemodilution （AHH） combined with tranexamic acid （TA） in neurosurgical operation. Methods Forty patients underwent selective neurosurgical operation were divided into two groups by radom digits table with 20 cases each, both groups were infused HES（130/0.4） 20 ml/kg for AHH after anesthesia, TA intravenous injection of loading 10 mg/kg, 1 mg/（ kg· h ） continuous infusion until the end of surgery in experimental group, only for AHH in control group. The mean arterial blood pressure（MAP）, central venous pressure（CVP）, heart rate （HR）, pulse oxygen saturation （SpO2） were measured before AHH （T0）, AHH immediately （T1）, 1 b after AHH（T2）, at the end of operation（T3）,and in the corresponding time hemoglobin（Hb）,hematocrit（Hct）, prothrombin time （ PT ）, activated partial thromboplastin time （ APTT ）, platetet （Plt）, fibrinogen （ FIB ） were measured; the intraoperative bleeding, blood transfusion and transfusion rate were counted in both groups. Results There was no significant difference in HR and MAP at different time between two groups （ P 〉 0.05 ） ,compared with T0,CVP at T1 ,T2 was increased （P 〈 0.05 ）, Hb and Hct at T1,T2,T3 were decreased （P 〈 0.05 ）. PT and APTT at T2, T3 were longer than that at To in control group （P 〈 0.05 ） ; Pit at T1, T2, T3 was lower in control group than that at To in two groups （P 〈 0.05 ）, Plt at T2, T3 was obviously increased in control group compared with experimental group （P 〈 0.01 ） ; FIB at T2, T3 was lower than that at To in control group （P 〈0.05）. The intraoperative bleeding, blood transfusion and transfusion rate in experimental group [（650 ± 560） ml, （150 ±50）ml,30%（6/20）] were lower than those in control group [（820 ±410） ml, （380 ±290） ml,60% （12/20）],there were significant differences between two groups （P 〈0.05）. Conclusion AHH combined with TA has obvious effect of saving blood and hemodynamic stability with less influence on coagulation in neurosurgical operation.