无创监测条件下急性高容量血液稀释的安全性

The safety of acute hypervolemic hemodilution under noninvasive wardship condition

目的 探讨无创监护条件下推广应用急性高容量血液稀释 (AHH)的安全性。方法 12 0例患者采用随机双盲法分为单纯AHH组 (Ⅰ组 )、AHH加控制性降压 (CH)组 (Ⅱ组 )和常规处理组 (Ⅲ组 )。应用无创多功能监护仪监测ECG、无创血压 (NIBP)、脉搏血氧饱和度 (SpO2 ) ,分别于麻醉诱导前、手术开始、手术结束、术后 72h时间点测定红细胞压积 (HCT)、血红蛋白 (HGB) ,同时测定相应时间点脉压心率乘积 (RPP =HR×脉压 )、ECG ST变化值、尿量及SpO2 。手术结束应用吸引瓶测量法与纱布称重法测定术中出血量及记录术中输血量。结果 Ⅱ组RPP较扩容前显著下降 (P <0 .0 1) ,其他两组则显著增加 ,且组间对比差异非常显著 (P <0 .0 1) ,显示AHH +CH有更加稳定的循环指标 ;手术开始Ⅰ组、Ⅱ组HCt、HGB显著下降 ,达到AHH扩容目的 ,Ⅲ组虽然也有下降 ,但较其他两组差异非常显著 ( P <0 .0 1) ;手术结束时Ⅰ组尿量较其他两组显著增多 (P <0 .0 1) ;Ⅰ组术中出血量未见显著改变 ,而术中输血量下降有显著意义 (P <0 .0 1) ,且术后HCt、HGB水平高于其他两组。结论 无创监护条件下实施AHH血液保护是安全的 。

Objective To investigate the safety of popularizing the acute hypervolemic hemodilution (AHH) under noninvasive wardship condition.Methods 120 patients were divided into three groups by double blind method.The group A was simple AHH,group B was AHH plus controlled hypertension (CH),and group C was the routine treatment one.The multi function wardship instrument was used to observe ECG and BP and SpO 2 etc.,and Hct and HGB was examined at different times,before anesthesia allurement,after the beginning of operation and 72 hours after operation.The RPP (the product of HP and BP) and the viaration value of ECG ST and urine volume and SpO 2 were recorded at the same time.The hemorrhage and blood transfusion amount was calculated after operation according to the measurement of the blood in inhaled bottle,the weight of pledget and the record of the transfusion amount.Results The RPP of group B was significantly lower after hypervolemic hemodilution (P<0.01),while the other two groups increased significantly and there were significant differences among groups (P<0.01).The values of Hct and HGB of group A and groups B after the beginning of operation were significantly decreased,as compared with that of group C (P<0.01),so that the AHH and the urine volume of group A after operation was significantly increased,as compared with those of the other two groups (P<0.01).Although the hemorrhage amount in operation among groups had no significant difference,the blood transfusion amount in operation of group A was significantly lower than those of the other two groups (P<0.01),and the values of Hct and Hb were higher than those of the other two groups.Conclusion It is safe to use acute hypervolemic hemodilution under noninvasive wardship condition to protect blood and the AHH plus CH scheme is the best measure.