2种急性血液稀释对老年脊柱手术患者CI、SVV及异体输血的影响

Influences of two kinds of acute hemodilution on CI,SVV and allogeneic blood transfusion in senile patients undergoing spinal surgery

目的:比较2种急性血液稀释对老年脊柱手术患者心脏指数(CI)、每搏量变异率(SVV)及异体输血的影响。方法:选取老年脊柱手术患者90例,随机分为N组、H组和C组,每组30例。N组和H组手术前分别行急性等容血液稀释(ANH)与急性高容血液稀释(AHH),C组不进行急性血液稀释。比较N组与H组血液稀释前后血红蛋白(Hb)、血细胞压积(Hct)、血小板(PLT)水平及碱剩余、血乳酸浓度;比较N组与H组麻醉前(T0)、血液稀释后15min(T_1)、血液稀释后30min(T_2)及术毕时(T_3)的平均动脉压(MAP)、CI、SVV等指标;记录N组、H组、C组术中出血量、异体输血量及输血例数。结果:(1) N组与H组血液稀释后Hb、Hct、PLT较血液稀释前下降(P<0.05),碱剩余、血乳酸血液稀释前后无明显变化(P>0.05);(2)与H组比较,N组T2、T3时MAP、CI升高(P<0.05),SVV下降(P<0.05);(3)3组术中出血量、异体输血例数差异无统计学意义(P>0.05)。N组和H组异体红细胞输注量少于C组(P<0.05),N组异体红细胞输注量少于H组(P<0.05)。结论:与AHH比较,ANH对老年脊柱手术患者的血流动力学影响较小,具有更为明显的节血效果。

Objective:To compare the influences of two kinds of acute hemodilution on CI,SVV and allogeneic blood transfusion in senile patients undergoing spinal surgery.Method:A total of 90senile patients undergoing spi-nal surgery were randomly divided into N group,H group and C group,30cases in each group.N group and H group received acute normovolemic hemodilution (ANH)and acute hypervolemic hemodilution (AHH)respectively before the operation,and C group did not received acute hemodilution.The levels of hemoglobin (Hb ), hematocrit (Hct ), platelet (PLT ), base excess and blood lactic acid were compared before and after acute hemodilution in N group and H group.Mean arterial pressure (MAP ), heart rate (HR ), cardiac index (CI)and stroke volume variation rate (SVV)before anesthesia (T 0 ), at 15min after blood hemodilution (T 1 ), 30min after blood hemodilution (T 2)and end of surgery (T 3)were compared in N group and H group.Intraoperative blood volume,allogeneic blood transfusion volume and blood transfusion cases were recorded in N group,H group and C group.Result:①Com-pared with C group before blood hemodilution,the levels of Hb,Hct,PLT decreased after blood hemodilution (P < 0.05)in N group and H group.The levels of base excess and blood lactic acid had no significant changes before and after blood hemodilution (P >0.05).②Compared with H group,MAP and CI increased and SVV decreased (P < 0.05)at T 2 and T 3 in N group.③There were no statistically significant differences on intraoperative blood volume,blood transfusion cases in three groups (P >0.05).Compared with C group,erythrocyte transfusion volume de-creased in N group and H group (P <0.05).Compared with H group,erythrocyte transfusion volume decreased in N group (P <0.05).Conclusion:Compared with AHH,ANH might have less influences on hemodynamics and more obvious effect of blood saving in senile patients undergoing spinal surgery.