万汶急性超容血液稀释对腰后路减压植骨内固定手术患者甲状腺激素水平的影响

Effects of acute hypervolumic hemodilution with voluven on thyroid hormone level in patients with posterior lumbar decompression and bone graft fixation

目的观察万汶(6%羟乙基淀粉130/0.4)急性超容血液稀释(AHH)对腰后路减压植骨内固定术患者甲状腺激素水平的影响。方法 60例ASAI^II择期行腰后路减压植骨内固定手术患者,随机分为三组:对照组(A)、林格液组(B)、万汶组(C)、每组20例。B组和C组均于麻醉诱导后手术前分别输入15 ml/kg林格液、万汶,术中连续监测血流动力学变化,记录输血量、出血量,并评估术后并发症严重程度。另外,分别于AHH前(T1)、AHH后(T2)、术毕(T3)、术后24 h(T4),检测血红蛋白(Hb)、红细胞压积(HCT)、游离三碘甲状腺原氨酸(FT3)、游离甲状腺素(FT4)、促甲状腺素(TSH)。结果①C组患者围术期甲状腺激素水平变化与其他两组相比更平稳,且FT3、FT4、TSH术中下降幅度与其他两组相比明显减小(P<0.05)。②C组患者围术期血流动力学变化与其他两组相比更平稳,且Hb、HCT术后下降幅度与其他两组相比明显减小(P<0.05)。③A组和B组输血量及输血例数显著多于万汶组(P<0.05)。④C组与其他两组相比,患者术后并发症明显减轻(P<0.05)。结论对腰后路减压植骨内固定手术患者实施术前AHH是安全的;术前万汶AHH不会引起围术期非甲状腺疾病综合征(NTIS);相反,术前实施万汶AHH的患者围术期甲状腺激素水平变化更平稳,更有利于患者的预后。

ObjectiveTo investigate the effects of acute hypervolumic hemodilution（AHH） with voluven（6% hydroxyethyl starch 130/0.4）on thyroid hormone level in patients with posterior lumbar decompression and bone graft-fixation.MethodsSixty ASA I^II patients scheduled for elective surgery were randomly divided into three groups： control group（groupA, n=20）, Ringer＇s solution group（groupB, n=20） and voluven group（groupC,n=20）. In group B and C, 15 ml·kg-1Ringer＇s solution or voluven were infused respectively after induction of anesthesia. HR, MAP, SpO2and CVP were continuously monitored in three groups. The amount of blood lost, blood transfusion. Blood samples were taken and the level of Hb, HCT, free triiodothyronine（FT3）、free thyroxine（FT4）、thyrotropin（TSH）were examined at different time points： before the AHH（T1）, AHH finished immediately（T2）, immediate post operation（T3）, and 24 hours post operation（T4）.Results① In group C, thyroid hormone levels were more steady than that observed in group A and B.Furthermore, FT3、FT4、TSH decreased slightly in group C at post operation compared with other two groups（P0.05）. At T4, the thyroid hormone level of group C rebound to normal, no non-thyroidal illness syndrome. ② Compared with group A and B, the hemodynamics of group C were more stable. The concentrations of Hb and HCT decreased slightly in group C post operation compared with other two groups（P0.05）. ③ Errhysis in 24h post operation, but the amount of blood transfusion in group A and B was larger than that in group C. ④ In group A and B, the complication was much more sever than that group C.ConclusionImplementing AHH with voluven before surgery in patients with posterior lumbar decompression and bone graft-fixation is safe; Implementing AHH with voluven is not the primary cause of non-thyroidal illness syndrome, oppositely, in group C the thyroid hormone level is more steady than that in group A and B.