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1.
目的:观察术中急性高容血液稀释(acute hypervolaemic hemodilution,AHH)联合控制性降压(controlled hypotension,CH)对老年肿瘤患者血液动力学和肾功能的影响. 方法:将择期行肿瘤根治术的老年患者40例随机分为AHH&CH组(Ⅰ组),CH组(Ⅱ组),每组20例.分别观察记录麻醉平稳动静脉导管置管完成后(基础值,T0)、手术开始即刻(T1)、停止降压30 min (T2)、术毕即刻(T3)两组各个时点的平均动脉压(MAP)、心率(HR)和中心静脉压(CVP),检测T0和T1、T3三个时点血红蛋白(Hb)浓度和红细胞比容(Hct),各个时点血清α1-微球蛋白(α1-MG)浓度并检测两组T0、T3时点的血浆尿素氮(BUN)和肌酐(Cr)值,记录降压期间尿量、Fromme术野质量评分、手术出血总量和输血量. 结果:两组T1时点MAP、HR值均低于T0、T2、T3时点(P<0.05),两组T2、T3时点的CVP值高于T0时点(P<0.05).两组T1、T3时点Hb和Hct低于T0(P<0.05);在T1时点,Ⅰ组的Hb和Hct低于Ⅱ组(P<0.05).两组T3时点血清α1-MG值均高于T0时点(P<0.05),Ⅰ组降压期间尿量多于Ⅱ组(P<0.05),输血病例数Ⅰ组少于Ⅱ组(P<0.05). 结论:老年肿瘤患者大手术中应用AHH联合CH技术与单纯CH,均能维持血流动力学稳定,对肾功能无明显影响.AHH联合CH能明显减少术中出血量,减少异体血输注.在当今血源紧缺的情况下,推广应用本技术具有临床实用意义和重要社会价值.  相似文献   

2.
目的:探析在脊柱外科手术中控制性降压联合急性等容量血液稀释的临床应用效果。方法:选取我院收治的行控制性降压(CH)联合急性等容量血液稀释(ANH)ASAⅠ~Ⅱ级脊柱手术20例患者为研究对象,并将其作为研究组,另选取ASAⅠ~Ⅱ级脊柱手术20例患者作为对照组。观察、比较两组患者在麻醉前(T_1)和手术开始前(即血液稀释后)(T_2)、术毕(T_3)、术后第一天(T_4)以及术后第五天(T_5)的Hct(红细胞比容)与Hb(血红蛋白)的数值。结果:相比T_1时点,研究组与对照组患者组间的T_2、T_3、T_4及T_5等各时点Hct和Hb情况比较,差异有统计学意义(P<0.05);研究组患者的Hct和Hb指标在T_2时点显著低于对照组,差异有统计学意义(P<0.05)。结论:行脊柱外科手术时采取CH联合ANH治疗,既能使血压保护得到充分完成,又能使同种异体输血情况降低,使患者失血量明显下降。  相似文献   

3.
刘建军 《重庆医学》2011,40(27):2742-2744
目的探讨颅脑肿瘤手术急性等容血液稀释(ANH)联合控制性降压(CH)对血流动力学和氧代谢的影响。方法选择2008~2009年该院收治的颅脑肿瘤手术患者60例随机分为两组:ANH联合CH组(A组)和单纯CH组(B组),每组30例。术中观察两组各设定时点的平均动脉压(MAP)、心率、中心静脉压(CVP)、心排血量、外周血管阻力(SVR)、乳酸(LAC)、血细胞比容(Hct)的变化,计算氧供、氧耗和氧摄取率(ERO2)。结果 MAP、心率、CVP、心排血量、SVR、LAC、Hct、氧供、氧耗和ERO2项目的不同时点比较差异有统计学意义(P<0.05)。结论术前ANH联合CH有助于颅脑肿瘤手术患者血流动力学的稳定,不影响机体氧代谢,且可有效减少术中用血。  相似文献   

4.
目的 观察术中急性高容量血液稀释(AHH)联合硝酸甘油控制性降压时血液动力学、氧代谢的变化,评价其可行性.方法 择期全麻手术病人40例,随机分为两组,每组20例.组Ⅰ为单纯AHH组,组Ⅱ为AHH联合应用硝酸甘油控制性降压(CH)组.组Ⅰ手术开始后在30 min内输入菲克雪浓15 mL/kg,CVP控制在16 cmH2O以内.组Ⅱ手术开始30 min内输注菲克雪浓15 mL/kg,同时以MAP基础值的70%为目标行CH.分别于麻醉诱导后(基础值,T0),AHH或AHH联合CH后30 min(T1),60 min(T2)记录血液动力学指标,同时采集中心静脉血,股动脉血测定血气及动脉血乳酸浓度(LAC),计算氧供(DO2),氧耗(VO2)和氧摄取率(ERO2).结果 AHH后,两组Hb、Hct在均明显下降(P<0.01).组ⅠMAP、CVP明显升高(P<0.01),组ⅡMAP、CVP无明显变化(P>0.05).与T0比较,两组在T1、T2的DO2、VO2、LAC均无明显变化(P>0.05).结论 AHH联合硝酸甘油CH,循环负荷增加少,CVP升高不明显,不易出现心力衰竭及肺水肿,能较好维持机体血液动力学和氧代谢的相对稳定,相对单纯AHH,临床应用更安全.  相似文献   

5.
侯永超  陈卉  张正辉  周述芝  冉鑫   《四川医学》2023,44(4):405-408
目的 观察神经外科手术患者中进行急性高容量血液稀释(AHH)联合控制性降压(CH)及自体血回输(ABT)对凝血功能的影响。方法 选择神经外科手术患者72例随机分为对照组和试验组,试验组在对照组基础上,加用AHH联合CH及ABT治疗。比较两组患者麻醉诱导前(T0)、麻醉诱导后30min(T1)、术后1 d(T2)的血常规、动脉血气分析、凝血功能及血栓弹力图(TEG)变化,记录两组患者术中出血、输血情况及输血相关并发症。结果 两组患者术中出血量差异无统计学意义(P<0.05)。与对照组比较,试验组异体血输注例数少于对照组(P<0.05);两组患者均无输血相关不良反应发生。与T0比较,两组患者T1和T2时的Hb、Hct及Plt明显降低(P<0.05);T2时试验组Hb、Hct、Plt、PaO2明显高于对照组(P<0.05)。T1和T2时,两组患者Lac、K+、PT、APTT、ACT、FIB、MA比较,差异无统计学意义(P<0.05)。结论 AHH联合CH及ABT用于神经外科手术患者可减少异体血使用量,对内环境及凝血功能无明显影响,在神经外科手术中应用安全。  相似文献   

6.
目的 观察急性高容量血液稀释(acute hypervolemic hemodilution,AHH)联合硝酸甘油控制性降压(controlled hypotension,CH)对脊柱手术患者术中局部脑氧饱和度(regional cerebral oxygen saturation,rScO2)以及术后认知功能的影响.方法 选取择期行腰椎后路减压内固定手术患者50例,ASA分级Ⅰ~Ⅱ级,随机分为急性高容量血液稀释联合控制性降压组(A组)和对照组(C组).A组麻醉诱导后,静脉滴注6%羟乙基淀粉130/0.4氯化钠注射液15ml/kg,30 min内输完后开始切皮,术中静脉泵注硝酸甘油进行控制性降压,将血压降至基础值的30%,MAP维持在50~60 mmHg.C组仅使用乳酸钠林格液补充生理需要量.记录2组患者入室(T0),急性高容量血液稀释后(T1,C组为诱导后30 min),控制性降压开始后10 min(T2,C组为手术开始后10 min),降压后20 min(T3),降压后30 min(T4)及停止降压后30 min(T5)6个时点的SBP、DBP、MAP、HR、BIS值及rScO2值.记录患者术中尿量、失血量及输血量,对比2组在T0、T1和R时点的血气分析结果,同时术前1d,术后24 h、72h及术后7d采用简易智力状态检查表(mini-men-tal state examination,MMSE)测定认知功能.结果 与降压前(T0)比较,A组SBP、DBP明显下降(P<0.05),C组SBP、DBP、HR无明显变化;血气结果显示,A组T1、T5时红细胞比容(HCT)和Hb较T0明显下降,与C组同时点比较亦明显降低(P< 0.05),C组变化不明显;C组失血量、输血量均显著多于A组(P<0.05),A组术毕尿量多于C组(P<0.05);2组患者各时点组内,组间rScO2差异均无统计学意义;2组间术后24 h、72h及术后7 dMMSE评分差异无统计学意义,随访均无术后认知功能障碍(post-operative cognitive dysfunction,POCD)发生.结论 AHH联合CH可安全用于非老年患者俯卧位脊柱手术中,CH可明显减少出血量,同时减少输血量;术中连续监测rScO2可及时发现术中脑氧供变化情况,及时调控,减少术后中枢神经系统并发症.  相似文献   

7.
目的 观察急性高血容量血液稀释联合硝酸甘油控制性降压用于脊柱前路手术的临床疗效.方法 将60例择期脊柱前路手术的病人按随机性原则分为A、B、C三组各20例.三组于术前均输注林格氏液及4%琥珀明胶,其中C组为快速大量输注方式;B、C组同时以平均动脉压(MAP)基础的70%目标,经微量泵静脉输入硝酸甘油控制性降压;结合MAP、HR、及CVP各指征变化调节用药速度,手术结束后停止降压;若术中出现Hb<80g/L,Hct<25%时予以输入红细胞悬液,术中连续监测MAP、HR、心电图(ECG)、CVP、呼末二氧化碳(PeTCO2)及血氧饱和度(SPO2),分别于术前,术后及术后24小时测Hb、Hct和Plt,记录术中出血量,输血量,尿量,及输液量.结果 B、C两组手术时间及术中出血量明显少于A组,差异具有统计学意义(P<0.05).T2A、B两组患者HR较T1明显增快(P<0.05);而C组病人HR无明显变化(P>0.05),T3时B组病人MAP较T1升高(P<0.05);C组病人CVP与T1比较有明显升高(P<0.05),A、B两组病人CVP无明显变化(p>0.05).三组患者T2及T3的Hb、Hct、Plt均较T1显著降低(P<0.05).结论 通过急性高血容量血液稀释 与硝酸甘油控制性降压在脊柱前路手术中联合应用,可减少患者术中出血量,缩短手术时间,同时对血流动力学等未见明显影响,是一种安全有效的临床保护方法.  相似文献   

8.
急性等容性血液稀释与控制性降压在脊柱手术中的应用   总被引:2,自引:1,他引:1  
目的探讨急性等容性血液稀释(ANHD) 控制性降压(CH)用于脊柱手术中对减少输异体血量及术后Hb和Hct的影响.方法择期脊柱手术患者100例,随机分成ANHD CH组,(Ⅰ组n=50)和对照组(Ⅱ组n=50),两组均采用气管内插管全麻,Ⅰ组术前进行急性等容血液稀释手术结束前回输自体血,术中采用CH将平均动脉压控制在110~80/70~50mmHg,并记录围术期二组的MAP、HR、CVP的变化.Ⅱ组按常规处理.于术前、术中(ANHD后)、术毕、术后第1天和术后第3天分别测定红细胞比容(Hct)、血红蛋白(Hb)的变化,并比较两组患者围术期出血量,尿量和补液输异体血的差异.结果手术时间组Ⅰ明显短于组Ⅱ,组Ⅰ有8例各输浓缩红血球2u,其余42例未输血,组Ⅱ患者在术中均输入异体血400~1200mL,术毕,Ⅰ组和Ⅱ组的Hb、Hct均明显低于术前(P<0.01),并且Ⅰ组低于Ⅱ组(P<0.05),术后第1天,术后第3天,两组患者的Hb、Hct显著低于术前.但两组比较差异无显著性(P>0.05).结论 ANHD结合控制性降压,可安全用于脊柱手术,可明显减少或避免输注异体血.  相似文献   

9.
【目的】观察中老年患者术中急性高容量血液稀释(acute hypervolemic hemodilution,AHH)联合尼卡地平控制性降压(controlled hypotension,CH)时血液动力学变化,评价其应用于老年患者的可行性。【方法】选择肝脏及胰十二指肠ASAII级手术患者30例,中年组15例,老年组15例,在麻醉诱导后手术开始前以30ml/min的速率输入6%羟乙基淀粉15ml/㎏,在AHH同时以平均动脉压(MAP)的70%为目标用尼卡地平行CH。分别于AHH前即刻(T0)、AHH完成即刻(T1)、AHH完成后30min(T2)、60min(T3)记录血红蛋白(Hb)、红细胞比容(Hct)及血液动力学指标。【结果】(1)两组在T0各指标的差异无统计学意义(P〉0.05)。(2)Hb、Hct:与T0相比,两组患者在T1、T2、T3的Hb、Hct均下降(P〈0.05),两组间Hb、Hct差异无统计学意义(P〉0.05)。(3)血液动力学:与T0相比:两组T2、T3的心率(HR)、心脏指数(CI)、心排血量(CO)、中心静脉压(CVP)上升(P〈0.05),MAP、周围血管阻力(SVR)下降(P〈0.05);与中年组相比,老年组在T2、T3时的CI、CO下降(P〈0.05),CVP上升(P〈0.05),MAP、HR、SVR差异无统计学意义(P〉0.05)。【结论】对于65岁以上、ASAII级,无明显心肺疾患的老年患者行腹部手术时,按照本研究所用急性高容量血液稀释的速率及水平,尼卡地平控制性降压的标准和时间,能维持机体血液动力学相对稳定,临床上具有可行性。  相似文献   

10.
目的 探讨高渗氯化钠羟乙基淀粉注射液(HSH)用于急性高容量血液稀释(AHH)联合控制性降压(CH)在脊柱手术中的安全性和有效性.方法 80例拟行脊柱手术的患者,随机均分为4组:CON组(不进行AHH与CH)、AHH组(用HSH进行输注)、CH组(用硝酸甘油进行降压)和AHH+CH组.术中持续监测 平均动脉压(MAP)、心率(HR)及中心静脉压(CVP);分别于AHH前(T0)、AHH后即刻(T1)、手术开始后1h(T2)、术毕(T3)各时间点检测患者的血细胞比容(HCT)、乳酸(LAC)、碱剩余(BE)、氧分压(PO2)、凝血酶原时间(PT)、活化部分凝血酶时间(APTT)、血Na+,K+,C1-的浓度、尿素氮(BUN)及肌酐(Cr),并记录术中输液量、输血量、出血量及尿量.结果① CH组与AHH+CH组在T2时点MAP下降;CH组在T2时点HR增快;AHH与AHH+CH组在T1时点CVP增高(P<0.05).②AHH组与AHH+CH组在T1时点HCT下降、Na+与C1-浓度以及PT与APTT增加(P<0.05);四组病人在各时点LAC、P02、SE、K+、BUN和Cr的差异无统计学意义(P>0.05).③四组患者术中输液量差异无统计学意义(P>0.05);CH组与AHH+CH组的出血量少于CON组及AHH组;AHH组与AHH+CH组的尿量多于CON组及CH组;AHH+CH组的输血量少于其它3组(P<0.05).结论 HSH用于AHH联合CH可以减少术中出血量,提高节约用血效果和改善微循环.  相似文献   

11.
Objective: To evaluatel the value of D-dimers in patients with acute aortic dissection (AAD). Methods: This study consisted of 16 patients with AAD and 27 non-AAD patients. Serum D-dimets were measured by Sta-Liatest D-DI immunoturbidimetric assay. Results: D-dimer level was higher (P < 0.001) in patients with AAD(7.91 ± 5.52 μg/ml) than that in non- AAD group(1.57±1.24 μg/ml). D-dimer was positive (>0.4 μg/ml) in all patients with AAD and in 10 control group patients (37%). Among patients with acute AAD, D-dimers tended to be higher in Stanford A than in Stanford B (8.67 ± 4.31 μg/ml vs. 3.24±1.27 μg/ml, P <0.01). D-dimer values tended to be higher in more extended disease(3.84 ± 1.65 μg/ml, 8.57 ± 3.58 μg/ml and 11.87 ± 5.69 μg/ml in thoracic aorta, thoracic and abdominal aorta, thoracic and abdominal aorta and iliacal arteries, respectively, P < 0.05 for both 8.57 ± 3.58 and 11.87 ± 5.69 vs. 3.84 ± 1.65 ). Including the control group into the analysis, we found a sensitivity of 100%, a negative predictive value of 100%, and a specificity of 66% and a positive predictive value of 64% for D-dimer in diagnosis of AAD in our patients with suspected AAD. Conclusion: D-dimer was elevated in patients with AAD. A negative D-dimer test result could be useful in excluding AAD.  相似文献   

12.
Objective: To set up a simple and reliable rat model of combined liver-kidney transplantation. Methods: SD rats served as both donors and recipients. 4℃ sodium lactate Ringer's was infused from portal veins to donated livers,and from abdominal aorta to donated kidneys, respectively. Anastomosis of the portal vein and the inferior vena cava (IVC) inferior to the right kidney between the graft and the recipient was performed by a double cuff method, then the superior hepatic vena cava with suture. A patch of donated renal artery was anastomosed to the recipient abdominal aorta. The urethra and bile duct were reconstructed with a simple inside bracket. Results: Among 65 cases of combined liver-kidney transplantation, the success rate in the late 40 cases was 77.5%. The function of the grafted liver and kidney remained normal. Conclusion: This rat model of combined liver-kidney transplantation can be established in common laboratory conditions with high success rate and meet the needs of renal transplantation experiment.  相似文献   

13.
Objective To observe blood pressure change with age in salt-sensitive teenagers whose salt sensitivity were determined by repeated testing.Methods Salt sensitivity was determined through intravenous infusion of normal saline combined with volume-depletion by oral diuretic furosemide in 55 teenagers. After five years, salt sensitivity was re-examined and subject blood pressure was followed up. Blood pressure changes in salt-sensitive teenagers were compared to that of non-salt sensitive teenagers over five years.Results After 5 years, the repetition rate of salt sensitivity determined by intravenous saline loading is 92.7%. In teenagers with salt sensitivity on the baseline, both the systolic blood pressure increments and increment rates were much higher than non-salt sensitive teenagers (12.7±12.1 mmHg vs. 2.8±5.2 mmHg, P< 0.01; 12.2%± 12.0% vs. 2.5% ±4.4%, P< 0.001,respectively). There was a similar trend for diastolic blood pressure (8.4 ± 6.4 mmHg vs. 3.7 ± 6.4 mmHg, P = 0.052; 13.2% ±10.6 % vs. 6.8%± 10.1%, P = 0.053, respectively).Conclusions Salt sensitivity determined by intravenous saline loading showed good reproducibility. Blood pressure increments with age were much higher in salt-sensitive teenagers than non-salt sensitive teenagers, especially in terms of systolic blood pressure.  相似文献   

14.
Shock wave lithotripsy (SWL) is a treatment of choice for upper urinary stones. However, this procedure is inappropriate for obese patients because the focus is often unable to reach the target owing to the limited focal distance in shock wave source. Although treating such patients in a blast path may increase the application length of shock wave source, it's difficult to find this path on the lithotripter monitor. For this reason, we invented an adjustable calibration marker in order to set an effective focus in the shock wave hath.  相似文献   

15.
Excess production of reactive oxygen species(ROS)of mitochondrion mediated by hyperglycemia is the common pathogenesis of angiopathic complications of diabetes.TCM holds that the damp from the dysfunction of spleen.kidney and liver is the causative factor of complications of diabetes.This is similar to the mechanism of Ros resulting in angiopathic complications of diabetes.When the angiopathic complications of type II diabetes mellitus(T2DM)are difierentiated as caused by turbid damp in TCM can be explained as ROS.Since the obstruction of pathogenic damp in channels and collaterals is said to be the main pathogenesis,the treating principle should be dissolving the damp to remove the obstruction.  相似文献   

16.
INTRODUCTION Obesity is a complex emergent problem, which can be possibly solved not only by the diet but also by the life style and promotion of a constant physical exercise. 1, 2 No doubt careful attentions must be given to the nutritional condition of obese people, the dietary habits, the somatic build (i.e. distribution of fat mass) and the organic functions linked to formation of the fat mass. All the parameters should be constantly monitored before, during and after a diet treatment. 3, 4, 5  相似文献   

17.
People with dysglycemia are at high risk for atherosclerotic diseases. This study aims at investigating the atherosclerotic vascular damage in dysglycemia and its metabolic origin in Tibetan population.  相似文献   

18.
FOR anesthesiologis s ,treatingpostoperativepainhas alwaysbeen a problem.Althoughopioidshave been provedtobe effective,theirsideeffectscouldnotbeignored.With thedevelopmentofscienceand pharmacology,many drugs with aspectsof satisfactoryanalgesicefficacyand couldbe welltoleratedby patientshave been developed.And lornoxicamisone of them, which isa non-steroidalanti-inflammatorydrug (NSAID ), with analgesic, anti-infl-ammatory,andantipyreticproperties.Itseliminationhalf-time(3 to 5 hours) isle…  相似文献   

19.
目的:评价使用安心颗粒对急诊经皮冠状动脉介入术(PPCI)术后生活质量的影响.方法:将160例接受PPCI的急性ST段抬高型心肌梗死患者随机分为安心颗粒组(术前顿服安心颗粒8.8g,术后安心颗粒4.4 g/次,每日2次)和对照组(仅接受基础药物治疗).所有患者均服用阿司匹林、氯吡格雷和阿托伐他汀.分别在入院时、出院前1d、出院后180 d时,应用心肌梗死多维度量表(MIDAS)、中文版SF-36评价量表对患者生活质量评分.并观察术后30 d以内的出血并发症、血小板减少症发生情况.结果:入院时和出院前1d,两组患者的心肌梗死MIDAS、SF-36量表评分比较无差异(P>0.05);出院后180 d时,与对照组比较,安心颗粒组MIDAS、SF-36评分明显减低(P<0.05);组内与入院时比较,两组出院前1d、出院后180 d时,MIDAS、SF-36评分均降低(P<0.05).两组患者在随访期间均无大量出血、少量出血、重度和极重度血小板减少症发生,安心颗粒组有4例、对照组有7例发生不明显出血(P>0.05).两组发生轻度血小板减少症的患者数比较无差异(P>0.05).结论:PPCI使用安心颗粒,能改善急性ST段抬高型心肌梗死患者的生活质量,且不增加出血风险.  相似文献   

20.
Objectives To explore serum cytokines levels (including IL-1 β, sIL-2R, IL-6, TNF-α, and IFN-v) and their significance in patients with acute coronary syndrome (ACS) and the subsequent follow-ups, with attempt to estimate the role of various serum inflammatory markers in the diagnosis and assessment of ACS.Methods The study population include 40 patients with acute myocardial infarction (AMI), 40 patients with unstable angina pectoris (UAP), and 40 controls. Among the 80 patients, 60 patients attended a follow up 4 months later. Serum inflammatory markers including IL-1 β, sIL-2R, IL-6, TNF-α, and IFN-v were measured by enzyme linked immunosorbent assay.Results Serum IL- 1 β, sIL-2R, IL-6, TNF-α were significantly higher in AMI group or UAP group compared to the control group and became significantly lower 4 months later in the follow-up patients. Serum levels of IFN-v shows no significant difference between AMI group or UAP group and controls, also showing no significant change when measured in follow up patients. There was no correlation between serum creatine kinase-MB isoenzyme levels and serum inflammatory markers either in UAP or AMI group. Furthermore, when divided into two subgroups using Wagner's QRS scoring system in the AMI group, there is no difference of each serum inflammatory marker between ≤ 6 scores group and > 6 scores group.Conclusion Serum levels of certain inflammatory markers may have some diagnostic value for ACS, and can be a useful marker reflecting disease stability.  相似文献   

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