AHH联合CH对老年全髋关节置换患者血流动力学及CTnⅠ的影响

Influence of acute hypervolemic hemodilution combined with nitroglycerin-induced controlled hypotension on haemodynamics and cardiac troponin Ⅰ in patients with total hip arthroplasty

目的:探讨急性高容量血液稀释(AHH)联合硝酸甘油控制性降压(CH)对老年全髋关节置换患者血流动力学及心肌肌钙蛋白I(CTnⅠ)水平的影响。方法:选择老年全髋关节置换手术患者106例。将患者随机分为AHH+CH组和CH组,每组53例。AHH+CH组手术前以30ml/min的速率经中心静脉输入6%羟乙基淀15ml/kg,同时以MAP基础值的70%为指标,给予硝酸甘油(0.5~5.0)μg·kg-1·min-1持续静脉输注行CH。CH组按照AHH+CH组方法进行CH。记录2组术中尿量、出血量和异体血输注量。记录2组术前即刻(T0)、CH后30mim(T1)、血压恢复正常时(T2)、术毕(T3)平均动脉压(MAP)、中心静脉压(CVP)及心率(HR)。采用化学发光法测定T_0、T_1、T_2、T_3、术后4h(T_4)、术后1d(T_5)时2组血浆cTnI水平。结果:(1)与CH组比较,AHH+CH组术中出血量、术中尿量及异体血输血量明显减少(P<0.05)。(2)与T0比较,T_1、T_2时CH组MAP降低(P<0.05),T2、T3时AHH+CH组CVP增高(P<0.05),T3时CH组CVP增高(P<0.05);T_1、T_2时CH组HR增快(P<0.05),但均在正常范围。CH组T_1、T_2时MAP、HR与AHH+CH组比较,差异有统计学意义(P<0.05)。(3)2组不同时间点及组间cTnI水平比较,差异均无统计学意义(均P>0.05)。结论:无明显心肺疾患的老年全髋关节置换患者,AHH与CH联合应用可节约血液资源,增加血流动力学的稳定性,不会造成心肌损伤。

Objective：To explore the influence of acute hypervolemic hemodilution（AHH）combined with nitroglycerin-induced controlled hypotension（CH）on haemodynamics and cardiac troponin I（cTnI）in the patients with total hip arthroplasty.Method：A total of 106 patients with total hip arthroplasty were enrolled in this study.All patients were randomly divided into AHH ＋ CH group（n=53）and CH group（n=53）.In AHH ＋ CH group,6% hydroxyethyl starch solution 15 ml/kg was infused at a rate of 30 ml/min before skin incision,at the same time nitroglycerin was infused at a rate of（0.5-5.0）μg·kg^-1·min^-1 and MAP was maintained at 70% of the base level.Controlled hypotension was implemented in CH group according to the methods of AHH ＋ CH group.Intraoperative urinary volume,amount of blood loss and allogeneic blood transfusion were recorded in two groups.Mean arterial pressure（MAP）,central venous pressure（CVP）and heart rate（HR）at preoperative immediately（T0）,30 mim after CH（T1）,blood pressure returned to normal（T2）and end of surgery（T3）were recorded in two groups.Plasma cTnI levels at T0,T1,T2,T3,postoperative 4 h（T4）and postoperative 1 d（T5）were determinated by chemiluminescence method.Result：（1） Compared with CH group,intraoperative blood loss,intraoperative urinary volume and allogeneic blood transfusion volume decreased significantly（P〈0.05）in AHH＋CH group.（2） Compared with T0,MAP reduced at T1 and T2 in CH group（P〈0.05）,CVP increased at T2 and T3 in AHH ＋ CH group（P〈0.05）,CVP increased at T3 in CH group（P〈0.05）,HR quickened at T1 and T2 in CH group（P〈0.05）,but those were all in normal range.Compared with AHH ＋ CH group,MAP and HR at T1 and T2 in CH group were significantly different（P〈0.05）.（3） Plasma cTnI levels at different time points and between groups were no statistically significant difference（P〈0.05）.Conclusion：For elderly total hip arthroplasty patients without cardiac and pulmonary diseases,AHH combined with CH could save blood resources,increase the stability of hemodynamics,and would not cause myocardial damage.