急性等容血液稀释联合控制性降压用于脊柱矫形手术

Effects of deliberated hypotension combined with acute isovolemic hemodilution on patients undergoing spinal column orthoraedy

目的 :了解急性等容血液稀释联合控制性降压法在脊柱矫形手术中对出血量和术后血红蛋白 (Hgb) ,红细胞压积 (Hct)的影响。方法 :选择脊柱矫形手术患者 2 0例 ,ASAⅠ～Ⅱ级 ,随机分成对照组 (组Ⅰ ,n =10 )和稀释组 (组Ⅱ ,n =10 )。行全麻气管插管 ,控制呼吸。组Ⅱ于麻醉后手术前进行急性等容血液稀释 (ANHD) ,术中结合控制性降压。组Ⅰ仅术中进行控制性降压。比较两组病人的出血量 ,输血量和术后Hgb、Hct变化。结果 :组Ⅱ病人术中平均出血 (45 0± 96 )ml,比组Ⅰ (980± 15 4 )ml明显减少。组Ⅰ病人平均输血 (6 10± 14 5 )ml,而组Ⅱ病人没有输血。术后两组病人均有轻度贫血。结论 :急性等容血液稀释联合控制性降压用于脊柱矫形手术可明显减少术中出血量 ,可避免输异体血。

Objective To study effects of deliberated hypotension combined with acute isovolemic hemodiluion on blood loss,postoperative hemoglubin of the patients undergoing spinal column orthoraedy.Methods Twenty ASA grade Ⅰ to Ⅱ adult patients undergoing spinal column orthoraedy were randomized to two groups:control group( n =10)and hemodiluion group( n =10).All patients were anesthetized with general anesthesia.In the hemodiluion group,Acute isovolemic hemodilution with hematocrit of 30% was accomplished by exchanging whole blood with hemaccel before operation,and deliberated hypotension was induced and maintained with sodium nitroprusside intermittent injection duing operation.In the control group,patients only received deliberated hypotension.Intraoperative blood loss,volume of blood to be transfused during operation, postoperative hemoglobin and postoperative hematocrit were recorded and compared between both groups.Results Blood loss in the hemodilution group was (450±96) ml and was lower than that(980±154) ml in the control group at the end of operation.The average volume of blood to be transfused during operation was (610±145 ) ml in the control group.Blood transfusion was avoided in the hemodilution group.Conclusion Deliberated hypotension combined with acute isovolemic hemodilution can significantly decrease the intraoperative blood loss undergoing spinal column orthoraedy.