ANIH联合瑞芬太尼控制性降压在骨科手术中的应用

Application of acute non-isovolemic haemodilution combined with remifentanil-induced hypotension on patients undergoing orthopedic operation

目的观察急性非等容性血液稀释(ANIH)和控制性降压联合应用于骨科手术的效果和安全性。方法将60例择期行复杂骨科手术患者随机分为观察组和对照组各30例,其中观察组麻醉诱导后行ANIH、术中泵注瑞芬太尼行控制性降压。分别于血液稀释前(T1)、血液稀释后15 min(T2)、术毕(T3)、术后1 d(T4)采血测定Hb、红细胞压积(Hct)、PLT、PT、APTT;监测术前、术中、术毕、拔管后30 min的平均动脉压(MAP)、HR,记录失血量、输注异体血例数及输血量。结果①两组手术时间、苏醒时间、拔管时间均无显著差异(P>0.05);与T1相比,观察组T2时点Hb、Hct、PLT均明显降低(P<0.05),且观察组T3时Hct显著低于对照组(P<0.05);两组凝血指标在各时点差异均无统计学意义(P>0.05)。②两组手术后MAP、HR均明显降低,且术中同时间点观察组MAP、HR均显著低于对照组(P<0.05),拔管后30 min两组MAP、HR相比差异无统计学意义(P>0.05)。③与对照组相比,观察组失血量、输注晶体液量及异体输血量、输血例数均明显降低(P<0.05);两组输注胶体液量及尿量均无显著差异(P>0.05)。④两组均未出现肺水肿、心衰、创面异常出血等不良事件。结论 ANIH联合控制性降压可有效减少骨科手术患者失血量,降低输血率和输血量,且安全性高。

Objective To evaluate the clinic effects and security of acute non-isovolemic haemodilution （ANIH） combined with remifentanil-induced hypotension on patients undergoing orthopedic operation. Methods Total of 60 patients undergoing complicated orthopedic operation were randomly divided into observed group and control group with 30 patients each. Patients in the observed group received ANIH and were infused with remifentanil for controlled hypotension. Blood routine（Hb, Hct,PLT）, standard coagulation tests（prothmmbin time, activated partial thromboplastin time） were performed before and 15 mins after ANIH（T1 ,T2）, at the end of the opetation （T3） and 1 day after the operation（T4）. Record the changes of mean arterial pressure and HR before operation, during operation, at the end of operation and 30 rains after tube drawing. Record the volume of blood loss, the volume and rate of allogenic blood transfusion of both groups. Results ①There was no significant difference between the two groups in operation time, recovery time and extubation time. In observed group, Hb, Hct and the number of platelets were significantly decreased after ANIH （P 〈0.05）, and Hot was significantly lower than that of control group at the moment of T3（P 〈0.05）. There was no significant differences between .the two groups in the values of PT and APTF （P 〉 0.05 ）. ②MAP and HR in the two groups were significantly decreased after the operation, MAP and HR in observed group were significantly lower than that of control group at the same moment during the operation（ P 〈 0.05 ） There was no significant differences between the two groups in the values of MAP and HR at the moment of 30 minutes after the operation（P 〉 0.05 ）. ③The volume of blood loss, the volume and rate of allogenic blood transfusion and the volume of crystalloid solution infusion were significantly decreased in observed group （ P 〈 0.05 ）,compared with that of control group. The differences of the volume of colloid solution infusion and urinary volume between the two groups were not significant（P 〉 0.05）. ④No lung edema, heart failure and unconventional bleeding were observed in two groups. Conclusions ANIH combined with remifentanil-induced hypotension can reduce the volume and rate of allogenic blood transfusion, as well as the volume of blood loss ,and also has high safety.