急性等容血液稀释自体血回输对老年骨科手术患者脑电双谱指数与肌松效应的影响

Effect of acute normovolemic hemodilution autologous blood transfusion on the EEG bispectral index and muscle relaxation in elderly patients undergoing orthopedic surgery

目的:观察急性等容血液稀释(ANH)自体血回输对老年骨科手术患者脑电双谱指数与肌松效应的影响,探究含有麻醉药成分的自体血回输对术后麻醉苏醒质量及安全性的影响。方法:择期骨科手术患者40例,年龄65~75岁,体质量55~80 kg,ASAⅠ~Ⅱ级,预计术中出血量≥600 mL。患者随机分为2组(n=20):A组为进行ANH组,在麻醉诱导平稳后实施ANH,血细胞比容(Hct)目标值28%~30%;B组为对照组,即术中常规补液,不进行ANH。于术毕回输自体血时(T_(1))、回输10 min(T_(2))、20 min(T_(3))、30 min(T_(4))、40 min(T_(5))、50 min(T_(6))、60 min(T_(7))各时点观测两组患者脑电双频指数(BIS)、四个成串刺激(TOF值)及丙泊酚、顺式阿曲库铵的血浆药物浓度变化;观察并记录术前(T 0)及T_(7)时点血气变化,观察患者拔除气管导管的时间以及苏醒质量。结果:A组BIS值在术后T_(6)、T_(7)时点明显低于B组(P<0.05),A组TOF值在T_(5)、T_(6)、T_(7)时点明显低于B组(P<0.05);A组与B组术后丙泊酚、顺式阿曲库铵的血药浓度组间比较差异无显著性(P>0.05);A组在术后T_(7)时点乳酸(Lac)值明显高于B组(P<0.05);A组拔除气管导管的时间明显长于B组(P<0.05);A组Aldrete评分明显低于B组(P<0.05)。结论:ANH后术毕自体血回输可增加血浆中麻醉药物浓度,加深患者的麻醉深度,增强肌松效应,使老年患者呼吸功能恢复和拔管时间延迟。

AIM:To observe the effect of acute normovolemic hemodilution(ANH)autologous blood transfusion on the EEG bispectral index and muscle relaxation in elderly patients undergoing orthopedic surgery to explore the influence of autologous blood transfusion containing anesthetic components on the quality and safety of postoperative anesthesia recovery.METHODS:Forty patients,aged 65-75,weighing 55-80 kg,ASA grade I-II,with an estimated intraoperative blood loss of more than 600 mL,were selected for elective orthopedic surgery.The patients were randomly divided into two groups(n=20):group A was given acute normovolemic hemodilution(ANH),and the target value of Hct was 28%-30%after induction of anesthesia;group B was the control group which was given routine fluid infusion during operation without ANH.Bispectral index(BIS),TOF values and plasma concentrations of propofol and cisatracurium were measured at the beginning of autotransfusion(T_(1)),10 min(T_(2)),20 min(T_(3)),30 min(T_(4)),40 min(T_(5)),50 min(T_(6))and 60 min(T_(7))of autologous blood transfusion.The changes of blood gas before operation(T 0)and at T_(7) time point were observed and recorded.The time of extubation of tracheal tube and the quality of recovery were observed.RESULTS:The BIS value of group A was significantly lower than that of group B at T_(6) and T_(7)(P<0.05),and the TOF value of group A was significantly lower than that of group B at T_(5),T_(6) and T_(7)(P<0.05);there was no significant difference between the blood concentrations of propofol and cisatracurium between group A and group B(P>0.05);the lactic acid value of group A at T_(7) was significantly higher than that of group B(P<0.05);the time of tracheal extubation in group A was significantly longer than that in group B(P<0.05);the Aldrete score of group A was significantly lower than that of group B(P<0.05).CONCLUSION:For patients with acute normovolemic hemodilution,autologous blood transfusion after operation can deepen the depth of anesthesia,enhance muscle relaxation effect,and delay the recovery of respiratory function and extubation time in elderly patients.