急性高容量血液稀释联合控制性降压及自体血回输在骨科脊柱手术中的应用

Role of acute hypervolemic hemodilution with controlled hypotension and autologous blood transfusion on spinal surgery

目的探讨急性高容量血液稀释联合控制性降压及自体血回输在骨科脊柱手术中的临床效果及安全性。方法骨科脊柱手术患者50例,分为两组,实验组采用急性高容量血液稀释、控制性降压及自体血回输技术,对照组不采取上述措施,比较两组血流动力学、血常规、凝血指标、术中出血量、自体血回输量与异体血输血量及局部脑组织氧饱和度(regional cerebral oxygen saturation,rSO2)变化。结果与对照组比较,实验组有创动脉血压(invasive artery blood pressure,IBP)下降,中心静脉压(central venous pressure,CVP)升高,红细胞压积(HCT)、血红蛋白(Hb)、血小板计数(PLT)均下降,术中异体血输入量减少,差异有统计学意义(P<0.05);术中平均出血量、活化部分凝血活酶时间(APTT)、凝血酶原时间(PT)、凝血酶时间(TT)、纤维蛋白原含量(FIB)及rSO2差异无统计学意义(P>0.05)。结论急性高容量血液稀释联合控制性降压及自体血回输可减少异体输血量,对血流动力学、凝血功能及脑组织氧合无不良影响,在骨科脊柱手术中应用较为安全。

Objective To observe the clinical efficacy and safety of acute hypervolemic hemodilution（AHH）in combination with controlled hypotension（CH）and autologous blood transfusion（ABT）on spinal surgery.Methods For this study,we enrolled 50 patients undergoing spinal surgery and randomly divided them into two groups.The experimental group received AHH in combination with CH and ABT,while the control group received none of the above treatments.We compared the parameters such as hemodynamics,blood routine and coagulation,the amount of intraoperative bleeding,autologous and allogeneic blood transfusion volume,and regional cerebral oxygen saturation（rSO2）between the two groups.Results In the experimental group CVP increased,while invasive artery blood pressure, HCT, Hb,PLT and the amount of allogeneic blood transfusion decreased significantly compared with those of the control group（P〈0.05）.As for the mean intraoperative blood loss,APTT,PT,TT,FIB and rSO2,there were no significant differences between the two groups（P〈0.05）.Conclusion AHH in combination with CH and ABT can reduce the amount of allogeneic blood transfusion and has no adverse effect on hemodynamics,blood coagulation or cerebral oxygenation in spinal surgery patients.It is a safe and effective blood protection procedure during spinal surgery.