术前急性超容性血液稀释结合控制性降压在严重烧伤患者早期切痂植皮术中的应用

Application of Acute Hypervolemic Hemodilution Combined with Controlled Hypotension in Severe Burn Patients Undergoing Early Excision and Grafting

目的观察急性超容量血液稀释(AHH)联合控制性降压(CH)应用于严重烧伤患者早期切痂植皮术后的节约用血效果及安全性。方法将40例Ⅱ～Ⅲ度烧伤面积在35%TBSA以上烧伤患者随机分为2组,每组20例。A组行AHH+CH,患者于切皮前经静脉快速输入6%羟乙基淀粉(20mL/kg,50mL/min),术中用硝酸甘油[0.5～1.0μg/(kg.min)]行控制性降压;B组为对照组,行常规麻醉处置。术中连续监测平均动脉压(MAP)、心率(HR)、脉搏血氧饱和度(SpO2)和中心静脉压(CVP);于稀释前、稀释后、术毕、术后第1天测定:红细胞压积(HCT)、血红蛋白(Hb)、凝血酶原时间(PT)、活化的部分凝血活酶时间(APTT)、动脉血氧分压(PaO2)、二氧化碳分压(PaCO2)和酸碱值(pH)。记录术中失血量、输血量。结果 A组术中失血量、输血量比B组要显著减少(P<0.01),但两组血液动力学、凝血功能,以及组织氧供差异无统计学意义。结论术前急性超容量血液稀释联合控制性降压可明显减少严重烧伤患者早期切痂植皮术中的失血量和异体血输入量,是一种安全有效的临床血液保护方法,值得推广。

Objective To observe the efficacy of acute hypervolemic hemodilution（AHH）combined with controlled hypotension（CH）in severe burn patients undergoing early excision and grafting,and the safety in blood conservation.Methods Forty severe patients with burn area over 35% TBSA were randomly divided into groups A and B.The patients in group A（n=20）were infused with 6% HES（20 mL/kg,50 mL/min）after induction and before operation,and controlled hypotension was induced with nitroglycerin before the end of surgery.MAP,HR,SpO2 and CVP were continuously monitored throughout operation;HCT,Hb,PT,APTT,PaO2,PaCO2 and pH were recorded respectively at 4 time points（before AHH,after AHH,the end of surgery and 1st day after surgery）.The amount of blood loss and blood transfusion in the procedures were also counted.Results Blood loss and blood transfusion were significantly decreased in group A（P0.01）.There were no significant changes in PaO2,PaCO2,hemodynamics and blood coagulation function during the study.Conclusion The application of AHH＋CH in severe burn patients can significantly reduce intraoperative blood loss,is a safe and effective clinical blood conservation method,and is worth popularizing.