瑞芬太尼控制性降压联合急性高容量血液稀释在贲门癌根治术中的应用

Application of acute hypervolemic hemodilution in combination with controlled hypotension carried by remifentanil in radical operation for cardiac carcinoma

目的探讨瑞芬太尼控制性降压联合急性高容量血液稀释(AHH)在贲门癌根治术中的临床效果。方法 40例接受贲门癌根治术的患者随机分为对照组和瑞芬太尼控制性降压联合AHH组(试验组),每组20例。监测并记录两组血压(SBP和DBP)、心率(HR)及中心静脉压(CVP)基础值及术中各时点数值,在术前1 d、AHH 1 h后和术后1 d测定两组血红蛋白(Hb)和红细胞比容(Hct)。记录术中出血量、输血量、尿量和术毕拔除气管插管时间。结果试验组控制性降压期间DBP、SBP和HR各值均较基础值及对照组明显下降(P<0.05),停止控制性降压后DBP、SBP和HR各值与基础值及对照组比较差异无统计学意义(P>0.05)。实验组AHH 1 h后Hb和Hct值明显低于基础值及对照组(P<0.05),但仍在正常范围。AHH 1 d后Hb和Hct值与对照组比较差异无统计学意义(P>0.05)。两组术毕拔管时间差异无统计学意义(P>0.05)。试验组出血量和输血量均少于对照组(P<0.05),尿量多于对照组(P<0.05),差异有统计学意义。结论瑞芬太尼在接受AHH的贲门癌根治术中实施控制性降压效果确切,安全可靠。瑞芬太尼控制性降压联合AHH在贲门癌根治术中实施可明显减少手术中出血和输血量,脏器灌注良好,对苏醒无延迟作用。

Objective To investigate the clinical efficacy of acute hypervolemic hemodilution（AHH）in combination with controlled hypotension carried by remifentanil in radical operation for cardiac carcinoma.Methods 40 patients planned to undergoing radical operation for cardiac carcinoma were randomly divided into controlled group（group C）and group of AHH in combination with controlled hypotension by remifentanil（group F）with 20 patients each.BP,HR and CVP on basal level and on some point-in-times during the operation were monitored and recorded.Hemoglobin（Hb）and hematocrit（Hct）were monitored the day before operation,1 h after AHH and one day after operation.The volume of blood loss,blood transfusion and urine volume during the operation were recorded.The time from the end of operation to extubation was also recorded.Results SBP,DBP and HR in group F during the procedure of controlled hypotension were significantly lower than those in group C and those on basal level（P〈0.05）,and there was no significant difference of SBP,DBP and HR after controlled hypotension in group F to those in group C and those on basal level（P〈0.05）.Hb and Hct in group F 1 h after AHH were lower than those in group C and those on basal level（P〈0.05）,but they were still within normal range.There was no significant difference of Hb and Hct between group F and group C 1 d after AHH（P〈0.05）.There was no significant difference of the time from the end of operation to extubation between the two groups（P〈0.05）.The volumes of blood loss and blood transfusion in group F were significantly less than those in group C（P〈0.05）.The volume of urine in group F was more than that in group C（P〈0.05）.Conclusions Controlled hypotension carried by remifentanil in patients undering radical operation for cardiac carcinoma in combined with AHH is safe,reliable and effective.AHH in combination with controlled hypotension carried by remifentanil can significantly reduce the volumes of blood loss and blood transfusion in patients underwent radical operation for cardiac carcinoma,and it did not prolong the awake time.The organ perfusion is good.