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目的观察不同种类液体急性等容血液稀释(ANH)对脊柱手术患者血流动力学的影响和血液保护效应。方法选择择期全麻下行后路脊柱手术的患者60例,男30例,女30例,年龄48~65岁,ASAⅠ或Ⅱ级,随机分为三组:ANH晶体组(A组)、ANH胶体组(B组)和对照组(C组),每组20例。A组和B组在俯卧位全麻下行ANH,目标Hct为32%,A组放血同时用3倍体积的复方乳酸钠稀释,B组放血同时用相同体积的羟乙基淀粉130/0.4氯化钠注射液稀释,C组不做ANH,为对照组。记录ANH前5 min(俯卧位后5 min,T0)、ANH结束后10 min(切皮前5 min,T1)、输血(包括异体血和自体血)前5min(T2)和输血结束后10min(T3)的MAP、HR、心脏指数(CI)、每搏量变异度(SVV)、Hb、Hct、Plt、凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)及BIS和体温;监测三组术中出血量、输血量(包括悬浮红细胞、血小板和新鲜冰冻血浆)、输注异体血患者例数、输液量及尿量。结果 T2、T3时A组MAP明显低于,SVV明显高于T0时和B、C组(P0.05);T1时A、B组CI明显高于T0时和C组(P0.05),T2、T3时B、C组CI明显高于T0时和A组(P0.05);T1、T3时A、B组Hb、Hct及Plt明显低于T0时(P0.05);T1、T2时A、B组Hb、Hct及Plt明显低于C组,T3时明显高于C组(P0.05);T2、T3时三组PT及APTT明显长于T0时,T3时A、B组PT及APTT明显短于C组(P0.05)。A、B组术中未输入悬浮红细胞,输入悬浮红细胞及输注异体血患者例数明显少于C组(P0.05);A组晶体液输入量明显多于B、C组,B组明显少于C组(P0.05);A、C组胶体液输入量明显少于B组(P0.05);A组尿量明显多于B、C组(P0.05)。三组术中出血量差异无统计学意义。结论 ANH可减少脊柱手术患者术中异体悬浮红细胞的输入量,有利于凝血功能的恢复,具有明显的血液保护效应;胶体液行ANH的扩容效果优于晶体液。 相似文献
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不同比例晶体和胶体混合液用于急性血液稀释的观察 总被引:1,自引:0,他引:1
目的:观察1:1、1:2、1:3三种晶体和胶体混合液用于血液稀释(血稀)的特点,探讨以何种比例混合较适宜。方法:选择40例择期手术病人,随机分为5组,每组8例,于静吸复合麻醉诱导后,经桡动脉采集自体血(总血容量的20%~30%),同时将一种稀释液按预定量作同步快速输毕,观察血稀前后的各项生理指标变化。结果:5组血流动力指标均稳定;ECG、SpO_2、P_(ET)CO_2正常;Hb、Hct、PLC、Fg和血浆比粘度均呈稀释性下降。血浆胶体渗透压(COP)在单晶组、1:1组、1:2组血稀后有显著性变化;在单胶组和1:3组血稀前后则基本无变化。结论:晶体液与胶体液的混合比例以1:3较为适宜。 相似文献
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急性等容性血液稀释对肝脏手术纤维蛋白降解产物D-二聚体和凝血功能的影响 总被引:3,自引:1,他引:2
目的探讨急性等容性血液稀释(ANH)对肝脏手术纤维蛋白降解产物D二聚体和凝血功能的影响。方法肝脏手术患者60例随机均分为三组,Ⅰ组行ANH,红细胞压积(Hct)为30%;Ⅱ组行ANH,Hct为25%;Ⅲ组为对照组不行ANH。所有行ANH患者均经肘部静脉或其他大静脉采血,放血时间为15~30min,血液存于含PCD的采血袋;下肢同步输注等容量6%羟乙基淀粉(HES),直到Hct降至30%或25%,并维持血液动力学稳定。所采集的血液室温保存于手术室,结合术中失血量和循环情况在手术结束前行自体输血;分别于ANH前、ANH后30、60min、手术结束和手术后12h采静脉血测定血小板计数(Plt)、凝血酶原时间(PT)、凝血酶时间(TT)、纤维蛋白降解产物D二聚体和Hct。结果Ⅰ、Ⅱ组术中出血量较Ⅲ组显著减少(P<0.05);Ⅰ、Ⅱ组ANH后和术中PT、TT较Ⅲ组显著延长(P<0.05,P<0.01),Plt显著下降(P<0.05,P<0.01),但仍在正常范围内,回输自体血后上述指标明显恢复,手术野和切口无异常出血;三组D二聚体无明显改变(P>0.05)。结论术前对肝脏手术患者进行ANH至Hct降至30%~25%之间是安全的,对凝血功能和纤溶系统无明显影响且可减少术中出血量。 相似文献
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急性非等容量血液稀释用于围术期老年患者的可行性 总被引:14,自引:0,他引:14
目的评估老年患者使用非等容量血液稀释(ANIH)的有效性及安全性,并与急性高容量血液稀释比较。方法38例老年患者,年龄65~80岁,ASA Ⅰ~Ⅱ级,随机分为两组:ANIH组(Ⅰ组),AHH组(Ⅱ组)。均采用硬膜外复合全麻。全麻诱导同时快速补充6%羟乙基淀粉1 000~1 200ml和乳酸林格氏液500 ml(25%~30%循环血量),Ⅰ组患者在诱导前采血400~600 ml(循环血量的10%~15%),并于手术结束前或预计Hct<24%予以回输。监测HR、BP、CVP、ST-T的变化,并抽血检测围术期Hct、胶体渗透压、动脉血乳酸的水平。结果 两组患者围术期生命体征平稳,诱导后两组各有16.7%(I组3/18)和15.O%(Ⅱ组3/20)的患者出现一过性的低血压,但两组患者CVP在血液稀释后均显著升高,Ⅱ组的升幅显著高于Ⅰ组(P<0.01)。Ⅱ组中有1例出现房颤。血常规检测提示,ANIH组的患者达到了中度血液稀释的目的(稀释后Hct:29.9%±3.9%),而AHH组仅可达到轻度血液稀释(稀释后Hct:32.9%±2.9%);手术结束时ANIH组的Hct显著高于AHH组分别为:31.5%±5.1%和27.7%±3.6%(P<0.01),而两组的出血量、各时段的胶体渗透压和动脉血乳酸水平无显著变化,均在正常值范围内。结论 ANIH稀释效率高,容量负荷干扰小,红细胞保护程度高,较AHH有更多的安全性和有效性,适合于老年患 相似文献
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目的 比较肠癌根治术病人麻醉诱导前6%羟乙基淀粉130/0.4.麻醉诱导后乳酸钠林格氏液血液稀释与麻醉诱导前乳酸钠林格氏液-麻醉诱导后6%羟乙基淀粉130/0.4血液稀释容量治疗的效果.方法 拟行肠癌根治术病人40例,ASA Ⅰ或Ⅱ级,年龄45~64岁,体重42~65 kg,随机分为2组(n=20),Ⅰ组麻醉诱导前经30min静脉输注6%羟乙基淀粉130/0.4 15 ml/kg,麻醉诱导后即刻经30 min静脉输注乳酸钠林格氏液15 ml/kg;Ⅱ组于麻醉诱导前经30 min静脉输注乳酸钠林格氏液15 ml/kg,麻醉诱导后即刻经30 min静脉输注6%羟乙基淀粉130/0.4 15 ml/kg.记录术中胶体液量、晶体液量、出血量、尿量和异体输血情况;于人室后(基础状态,T0)、麻醉诱导后即刻(T1、15 min(T2)、60 min(T3)、120 min(T4)及术毕(T5)时记录平均动脉压(MAP)、中心静脉压(CVP)和心率(HR);于T0、T1、T3、T5时抽取桡动脉血样1 ml行血气分析,并测定血红蛋白浓度(Hb)和红细胞压积(Hct).结果 两组均未输异体血,术中胶体液用量,晶体液用量、出血量、尿量差异无统计学意义(P>0.05);与基础值比较,Ⅰ组术中MAP、HCO-3、血浆乳酸、Na+、K+的浓度差异无统计学意义(P>0.05),CVP升高,HR、Hct、Hb降低,术毕时pH值降低,Ⅱ组术中CVP升高,MAP、HR、pH值降低,术毕时HCO-3降低(P<0.05),血浆乳酸、Na+、K+的浓度差异无统计学意义(P>0.05);与Ⅰ组比较,Ⅱ组术中CVP升高,术毕时血浆乳酸浓度降低(P<0.05).结论 肠癌根治术病人采用麻醉诱导前6%羟乙基淀粉130/0.4-麻醉诱导后乳酸钠林格氏液血液稀释的容量治疗效果较好. 相似文献
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目的 探讨在颅脑外科手术中联合应用预贮式自体输血和急性等容性血液稀释的安全性和临床效果。方法 63例病人随机分为预贮式自体输血组(A组31例)和联合应用预贮式自体输血和急性等容性血液稀释组(B组32例)。两组在采血前、术前即刻放血前、放血后、回输自体血后、术后第1天分别测定Hb、Hct、Pt及PT、APTT、FIB,监测MAP、CVP、SpO2、HR,两组出血量、输异体血量。结果 A、B组Hb、Hct术中降低,与术前比较有显著性差异(P<0.05),回输自体血后回升。A、B两组PT、APTT术中延长,FIB和Pt未见明显改变。两组术中血流动力学稳定。A组采血量明显少于B组(P<0.05),输异体血量明显多于B组(P<0.05)。结论 联合应用预贮式自体输血和急性等容性血液稀释有明显节血效应,对血液生理学影响小,血流动力学稳定。 相似文献
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中度急性等容性血液稀释对凝血功能的影响 总被引:4,自引:0,他引:4
急性等容性血液稀释(acute normovolemic hemodilution,ANH)是自体输血的一种,一般是在麻醉后和手术主要步骤开始之前,抽取患者预定量的自体血液贮存于手术间,同时补充等效容量的晶体液或胶体液,以此达到快速血液稀释的目的,有输血指征或手术结束前再将采集的新鲜自体血反顺序回输给患者。稀释程度一般以大血管内红细胞压积(hematocrit,Hct)表示,Hct在45%~30%为轻度稀释,30%~20%为中度稀释,20%~10%为重度稀释。ANH如果正确用于合适的患者,可达到不输异体血或少输异体血的目的。但目前尚对其引起的凝血功能变化缺乏较全面的了解。本试验是探讨使用6%HES进行中度ANH时对凝血功能的影响,并指导临床应用。 相似文献
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目的:观察应用晶体液或胶体液行急性血液稀释期间机体生理变化,为临床应用提供理论依据。方法:30例外科择期手术病人随机分属三组:①乳酸纳林格液(RL)组;②右旋糖酐葡萄糖液(D40)组;③海脉素(Hm)组。麻醉诱导后,经桡动脉穿刺采血,同时经外周静脉输注等量Hm或D40或3倍采血量的RL。采血量按预计全血总量的20%~25%计算。观察血稀前后机体血流动力学、血清电解质、血浆胶体渗透压及其它生理参数的变化。结果:①三组的血流动力学参数均稳定;②血红蛋白(Hb)、血细胞压积(HCT)、血小板计数(PLC)均呈稀释性下降,Hb和HCT分别降至90g/L和29%,提示属中度血液稀释;③RL组、Hm组血清电解质含量无显著性变化,D40组血清Cl^-、Na^ 浓度降低显著;④RL组胶体渗透压显著降低,D40组和Hm组无明显变化。结论:①采用晶体液或胶体液作为稀释液施行中度血液稀释时,循环稳定,机体耐受良好;②晶体液可导致胶体渗透压降低;右旋糖酐可影响凝血功能,其临床应用受到一定的限制;③海脉素封血清电解质、胶体渗透压的影响轻微,用作稀释液的效果较为良好。 相似文献
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目的研究急性等容血液稀释(ANH)联合控制性降压(CH)对老年骨科手术患者血管外肺水及氧合的影响。方法选择择期行骨科手术的老年患者45例,男23例,女22例,年龄65~75岁,ASAⅠ或Ⅱ级。随机分为三组,每组15例:对照组(A组):术中常规输入晶体液和胶体液补充血容量;ANH组(B组):麻醉诱导平稳后,手术前进行ANH,目标Hct 30%;ANH联合CH组(C组):手术前进行ANH,持续泵注硝酸甘油,辅助艾司洛尔,将目标MAP控制在基础值的70%。分别于诱导前(T_1)、血液稀释后即刻(T_2)、血液稀释后30 min(T_3)、CH达到目标MAP 30 min后(T_4)、术毕(T_5)采集动脉血样做血气分析,监测并记录MAP、HR、PaO_2、SpO_2、Hct、HCO~-_3、pH、心脏指数(CI)、每搏变异量(SVV)、每搏指数(SVI)、血管外肺水指数(EVLWI)及胸内血容量指数(ITBVI)的变化,并记录采血量、出血量、尿量及手术时间等。结果 B组和C组采血量差异无统计学意义,A组未做自体血采集。C组出血量明显低于A组和B组(P0.05)。A组有6例,B组有1例输注异体血,C组未输注异体血。与T_1时比较,T_2~T_5时三组MAP、HR、CI、SVI和Hct明显降低(P0.05),但均稳定在正常范围内。与T_1时比较,T2~T4时三组SVV明显降低(P0.05)。与T_1时比较,T_2~T_5时三组ITBVI、PaO_2和SpO_2明显升高(P0.05),但均稳定在正常范围内。T_2时A组CI、SVI明显低于B组和C组(P0.05)。与A组和B组比较,T_4时C组MAP明显降低、SVV明显升高(P0.05)。三组患者尿量、手术时间、EVLWI、HCO~-_3和pH组间组内差异均无统计学意义。结论急性等容血液稀释联合控制性降压用于老年骨科手术患者节约用血效果确切,对血管外肺水及氧合未产生不利影响,但联合应用时需加强监测。 相似文献
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目的 分析非转流原位肝移植术患者术中血浆胶体渗透压的变化.方法 择期经典非转流原位肝移植术患者30例,年龄35~60岁,ASA Ⅱ~Ⅳ级,肝功能Child-Push分级B或C级.静脉注射咪达唑仑、舒芬太尼、异丙酚及维库溴铵行麻醉诱导,静脉输注异丙酚,吸入异氟醚,并间断静脉注射舒芬太尼及维库溴铵维持麻醉.术中静脉输注入血白蛋白注射液及新鲜冰冻血浆等液体,无肝前期维持血红蛋白浓度70~80 g/L,尿量1 ml·kg-1·h-1,中心静脉压4~7 mm Hg;无肝期维持血红蛋白浓度80~100 g/L,尿量0.5 mll·kg-1·h-1,中心静脉压0~3 mm Hg;新肝期维持尿量1-2 ml·kg-1·h-1,中心静脉压4~10 him Hg.于建立肘正中静脉通路时(T0)、切皮即刻(T1)、无肝前期60 min(T2)、无肝即刻(T3)、无肝期30 mm(T4)、新肝即刻(T5)、新肝期30 min(T6)及术毕(T7)时取静脉血样5 ml,测定血浆胶体渗透压、血浆晶体渗透压及血清白蛋白浓度.结果 与T0时比较,T2-6时血浆胶体渗透压、T2-7时血清白蛋白浓度及T4-7时血浆晶体渗透压均升高(P<0.05或0.01),但仍在正常范围内.结论 非转流原位肝移植术中常规液体管理可维持正常血浆胶体渗透压,提示常规液体管理方案是可行的. 相似文献
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Mark A. Fontana Wasif Islam Michelle A. Richardson Cathlyn K. Medina Alexander S. McLawhorn Catherine H. MacLean 《The Journal of arthroplasty》2021,36(5):1511-1519.e5
BackgroundAbsenteeism is costly, yet evidence suggests that presenteeism—illness-related reduced productivity at work—is costlier. We quantified employed patients’ presenteeism and absenteeism before and after total joint arthroplasty (TJA).MethodsWe measured presenteeism (0-100 scale, 100 full performance) and absenteeism using the World Health Organization’s Health and Work Performance Questionnaire before and after TJA among a convenience sample of employed patients. We captured detailed information about employment and job characteristics and evaluated how and among whom presenteeism and absenteeism improved.ResultsIn total, 636 primary, unilateral TJA patients responded to an enrollment email, confirmed employment, and completed a preoperative survey (mean age: 62.1 years, 55.3% women). Full at-work performance was reported by 19.7%. Among 520 (81.8%) who responded to a 1-year follow-up, 473 (91.0%) were still employed, and 461 (88.7%) had resumed working. Among patients reporting at baseline and 1 year, average at-work performance improved from 80.7 to 89.4. A Wilcoxon signed-rank test indicated that postoperative performance was significantly higher than preoperative performance (P < .0001). The percentage of patients who reported full at-work performance increased from 20.9% to 36.8% (delta = 15.9%, 95% confidence interval = [10.0%, 21.9%], P < .0001). Presenteeism gains were concentrated among patients who reported declining work performance leading up to surgery. Average changes in absences were relatively small. Combined, the average monthly value lost by employers to presenteeism declined from 15.3% to 8.3% and to absenteeism from 16.9% to 15.5% (ie, mitigated loss of 8.4% of monthly value).ConclusionAmong employed patients before TJA, presenteeism and absenteeism were similarly costly. After, employed patients reported increased performance, concentrated among those with declining performance leading up to surgery. 相似文献
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As well for optimized emergency management in individual cases as for optimized mass medicine in disaster management, the principle of the medical doctors approaching the patient directly and timely, even close to the site of the incident, is a long-standing marker for quality of care and patient survival in
Germany. Professional rescue and emergency forces, including medical services, are the “Golden Standard” of emergency management systems. Regulative laws, proper organization of resources, equipment, training and adequate delivery of medical measures are key factors in systematic approaches to manage
emergencies and disasters alike and thus save lives. During disasters command, communication, coordination and cooperation are essential to cope with extreme situations, even more so in a globalized world. In this article, we describe the major historical milestones, the current state of the German system in emergency and disaster management and its integration into the broader European approach. 相似文献
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Differences in Osteocyte Density and Bone Histomorphometry Between Men and Women and Between Healthy and Osteoporotic Subjects 总被引:2,自引:0,他引:2
Mullender MG Tan SD Vico L Alexandre C Klein-Nulend J 《Calcified tissue international》2005,77(5):291-296
Bone defects related to osteoporosis develop with increasing age and differ between males and females. It is currently thought
that the bone remodeling process is supervised by osteocytes in a strain-dependent manner. We have shown an altered response
of osteocytes from osteoporotic patients to mechanical loading, and osteocyte density is reduced in osteoporotic patients,
which might relate to imperfect bone remodeling, leading to lack of bone mass and strength. Hence, information on osteocyte
density will contribute to a better understanding of bone biology in males and females and to the assessment of osteoporosis.
Osteocyte density as well as conventional histomorphometric parameters of trabecular bone were determined in cancellous iliac
crest bone of healthy postmenopausal women and men and of osteoporotic women and men. Osteocyte density was higher in healthy
females than in healthy males and lower in osteoporotic females than in healthy females. Bone mass was reduced in osteoporotic
patients, both male and female. In females, trabecular number was reduced, whereas in males, trabecular thickness was reduced
and eroded surface was increased. There were no correlations between the parameter groups bone architecture, bone formation,
bone resorption, and osteocyte density. These results are consistent with impaired osteoblast function in osteoporotic patients
and with a different mechanism of bone loss between men and women, in which osteocyte density might play a role. The reduced
osteocyte numbers in female osteoporotic patients might relate to imperfect bone remodeling leading to lack of bone mass and
strength.
M. G. Mullender and S. D. Tan contributed equally to this work. 相似文献
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目的探讨肝内胆管囊腺瘤和囊腺癌的CT、MRI和病理特点。方法回顾性分析经手术病理证实的6例肝内胆管囊腺瘤和2例肝内胆管囊腺癌的影像及临床病理资料,将病变的影像表现与其病理大体形态及组织学表现作对照分析。结果6例肝内胆管囊腺瘤,女4例、男2例;2例肝内胆管囊腺癌均为女性病人;8例病人平均年龄55岁。所有病灶均表现为多房囊性肿块,肿瘤囊腔各分房内常为多种液体成分,在CT上可表现为不同密度、在MRI上可表现为不同信号强度。囊内出现多发大小不等的壁结节在胆管囊腺癌内更常见,囊内有分隔但无壁结节只见于胆管囊腺瘤。在7例CT扫描中,4例胆管囊腺瘤和1例胆管囊腺癌可见囊壁或分隔上钙化,囊壁、囊内分隔及囊内结节均为轻、中度延迟增强。肿瘤中出现卵巢样间质见于3例胆管囊腺瘤和1例胆管囊腺癌,且均为女性病人。结论肝内胆管囊腺瘤和囊腺癌是肝脏不常见的囊性肿瘤,影像上多房、囊内有分隔且各分房囊内密度或信号不一致,高度提示肝内胆管囊腺瘤或囊腺癌的诊断,如囊内伴有多发大小不等的结节,则进一步提示囊腺癌的可能。但影像学表现不能区分肿瘤中有无卵巢样间质。 相似文献