急性高容血液稀释联合控制性降压用于老年病人脊柱手术的临床研究

目的观察术前急性高容血液稀释（AHH）联合控制性降压（CH）技术用于老年病人腰椎手术的有效性和安全性。方法选择拟行腰椎手术老年患者60例,ASAI-Ⅱ级,分成急性高容血液稀释联合控制性降压（H组）和对照组（R组）,每组30例。H组在麻醉诱导平稳后以15 ml/kg（50 ml/min）输注6%羟乙基淀粉130/0.4氯化钠注射液行AHH,于手术前15 min开始,以MAP基础值的75%-85%为目标行降压。R组常规输液。不同时间点采集桡动脉及颈静脉血测定血气、凝血功能指标。结果两组患者围术期HR、RR、SpO2、CVP、血乳酸的变化差异无统计学意义（P〉0.05）。H组术中失血量、异体血需求比例及平均输异体血量比R组明显减少（P〈0.05）。H组稀释后Hct明显低于R组（P〈0.05）;两组PT、APTT与诱导前比较明显延长（P〈0.05）,FIB与诱导前比较明显降低（P〈0.05）,但指标在正常范围。结论 AHH联合CH用于老年患者脊柱手术,血流动力学平稳,能减少手术出血和输血量,对微循环灌注及凝血功能影响小。

Clinical study on acute hypervolemic hemodilution combined with controlled hypotension in elderly patients undergoing spinal internal fixation

Objective To investigate the effects of acute hypervolemic hemodilution（AHH） combined with controlled hypotension（CH） in elderly patients undergoing spinal internal fixation.Methods Sixty ASAⅠ-Ⅱelderly patients undergoing elective operation of spinal internal fixation were randomly divided into AHH combined with CH group（group H） and control group（group R）.In group H,AHH was carried out after anesthesia induction.6%HES130/0.4 was transfused at 15 ml/kg and 50 ml/min and CH was carried out based on the MAP of the values of the 75%-85% as the goal line.Conventional saline was transfused in group R.Arterial and venous blood samples were collected for the measurement of blood gas analysis and thrombin activity index.Results There were no significant differences in HR,RR,SpO2,CVP and blood lactate between two groups（P0.05）.Blood loss and blood transfusion were significantly lower in group H than those in group R（P0.05）.In group H,Hct decreased evidently after AHH and was lower than that in group R（P0.05）.PT and APTT were more extended and FIB decreased evidently than pre-induction in both groups,but there was no statistical significance.Conclusion AHH combined with CH in elderly patients undergoing spinal internal fixation could make hemodynamic stable,decrease blood loss and reduce transfusion of homologous blood,and it has no adverse effect on tissue perfusion and coagulation function.