控制性降压结合单纯血液稀释用于脊柱侧(后)凸矫正术临床研究

A Clinical Study of Deliberated Hypotension Combined with Acute Simple Hemodilution on Patients Undergoing Spinal Side(back) Protrude Correction

目的 了解控制性降压结合单纯血液稀释在脊柱侧 (后 )凸矫正术中对出血量和术后Hb的影响。方法 择期脊柱侧 (后 )凸矫正术病人 2 4例 ,随机分成对照组 (Ⅰ组 ,n =12 )和降压组 (Ⅱ组 ,n =12 ) ,两组病人都采用气管内全麻。术前术中Ⅱ组病人用出血量的 3倍平衡液和海脉素行血液稀释并进行控制性降压 ,比较两组病人的出血量、输血量和术后血红蛋白。结果 Ⅱ组病人术中平均出血量 (6 0 0± 96 )ml,比Ⅰ组病人 (12 35±188)ml,减少 51% ;Ⅰ组病人术中平均输血量 (12 0 0± 140 )ml,而Ⅱ组病人为 (4 0 0± 12 8)ml。两组病人术后均有轻度贫血 ,但仍在安全水平以上 ,组间差异无显著性 (P >0 0 5)。结论 控制性降压结合单纯性血液稀释用于脊柱侧 (后 )凸矫正术 ,对有指征病人使用可减少术中用异体血。

Objective To study the effects of deliberated hypotension combined with acute simple hemodilution on blood loss,postoperative hemoglubin of the patients undergoing spinal side(back) protrude correction(SSP).Methods Twenty four ASA grade Ⅰ to Ⅱ patients undergoing elective SSP were randomly divided into two groups:control group(n=12) and hypotensive group(n=12).The all patients received with general anesthesia.In the hypotensive group:acute simple hemodilution was accomplished with infusion of lactated Ringer's solution and Gelofusine of as three times as blood loss.Deliberated hypotensin was induced and maintained with 0 01% sodium nitroprusside 2～6μg/kg/min iv.Intraoperative blood loss,blood transfused volume during operation and postoperative hemoglobin were recorded and compared between both groups.Results Blood loss was about 51% lower in the deliberated hypotensive group than that in the control group at the end operation.The average volume of transfused blood during operation was(1200±140)ml in control group,blood transfusion was(400±128)ml in the hypotensive groups.Conclusion Deliberated hypotension combined with acute simple hemodilution can significantly decrease the intraoperative blood loss and the SSP operation can be better tolerated for the indicated patients.