AHH联合CH对膀胱癌患者脑氧供需平衡及术后生存率的影响

Influence of acute hypervolemic hemodilution combined with controlled hypotension on cerebral oxygen supply,balance of cerebral oxygen supply and the postoperative survival rate in patients with bladder cancer

目的:观察急性高容量血液稀释(acute hypervolemic hemodilution,AHH)联合控制性降压(controlled hypotension,CH)对脑氧供需平衡及术后生存率的影响,评价其在膀胱癌根治手术中的应用价值。方法:选取行膀胱癌根治手术患者35例,随机分为AHH联合CH组(18例)和AHH组(17例),AHH联合CH组患者进行急性高容量血液稀释联合控制性降压,AHH组患者仅进行高容量血液稀释,记录麻醉诱导后(T0)、术后30 min(T1)、术毕(T2)不同时间点的动脉血氧饱和度、动脉血氧分压、颈内静脉血氧分压、二氧化碳分压、中心静脉压(central venous pressure,CVP)等指标,分析两组患者的生存情况。结果:与T0比较,T1、T2的颈内静脉血氧含量(jugular oxygen content,CjvO_2)在两组患者中均无明显变化,差异无统计学意义(P>0.05),而动脉血氧含量(cerebral arterial oxygen content,CaO_2)、动-颈静脉血氧含量差(cerebral arterial-venous oxygen content differenc,CajvO_2)在两组中均下降(P<0.05)。AHH组患者CjvO_2和脑氧摄取率(cerebral O2extraction rate,CERO_2)在T0、T1和T2的之间的差异无统计学意义(P>0.05),而在AHH联合CH组中,T1和T2的CaO_2、CajvO_2和CERO_2均低于T0(P<0.05)。在T1和T2时,AHH联合CH组患者的CajvO_2、CVP、CERO_2低于AHH组(P<0.05)。术后两组患者的生存率比较差异无统计学意义(P>0.05)。结论:AHH联合CH可维持患者脑氧供需平衡及循环稳定,且不影响患者术后生存率,能安全应用于膀胱癌根治手术患者。

Objective：To investigate the influence of acute hypervolemic hemodilution （AHH） combined with controlled hypotension （CH） on cerebral oxygen supply, balance of cerebral oxygen supply and the postoperative survival rate in patients with bladder cancer and evaluate its application value in the radical operation of bladder cancer. Methods：35 patients who had been performed radical operation of bladder cancer were randomly divided into the AHH combined with CH group （ 18 cases） and the AHH group （ 17 cases） . The arterial oxygen saturation （ SaO2）, partial pressure of O2（ PaO2）, jugular venous oxygen partial pressure （ Pj- vO2） , carbon dioxide partial pressure, central venous pressure （CVP） of the two groups after anesthesia induction （T0）, 30 min after the surgery （T1） and at the end of surgery （T2） were measured. The survival rates of the two groups were analyzed and compared. Results： Compared with that of the T0）, there was no signifi- cant change in terms of Jugular oxygen content （ CjvO2 ） at T1 and 12 （ P 〉 0.05 ） , while cerebral arterial oxygen content （ CaO2） and cerebral arterial - venous oxy- gen content （CairO2） decreased significantly at T1 and I2 in the two groups （ P 〈0.05 ）. In the AHH combined with CH group, the Ca02, Cajv02, CERO2 of T1 and T2 were significantly lower than those of TO （ P 〈 0.05 ） ; Cajv02, CVP and CERO2 in the AHH combined CH group were significantly lower than those in the AHH group at TI and T2 （ P 〈 0. 05）. There was no significant difference in terms of the survival rates between the two groups （ P 〉 0.05）. Conclusion： APIH combined with CH can maintain the balance of cerebral oxygen supply and demand and has no influence on the survival rate of patients, which can be safely used in patients with radical operation of bladder cancer.