急性高容量血液稀释联合控制性降压用于鼻内窥镜手术血液保护效果观察

目的评价急性高容量血液稀释（AHH）联合控制性降压（CH）用于鼻内窥镜手术中的血液保护效果。方法选择需行鼻内镜手术患者70例,性别不限,年龄20~55岁,ASAⅠ或Ⅱ级。随机分为2组,即AHH＋CH组（n=35）和CH组（n=35）。两组患者均在手术开始后静脉输注硝酸甘油,速率为0.3~1μg/（kg·min）进行控制性降压,在10~15min将MAP降至60~65mmHg。心率〉100次/min时单次静脉给艾司洛尔20mg。AHH＋CH组：麻醉气管插管后即刻至切皮前即刻,静脉输注6%羟乙基淀粉130/0.4溶液15ml/kg,速率50ml/min。记录两组患者术中心率（HR）,平均动脉压（MAP）,中心静脉压（CVP）,血氧饱和度（SpO2）,出血量,尿量,手术时间及异体输血情况。结果与CH组比较,AHH＋CH组手术时间缩短,术中出血量减少,尿量增多（P〈0.01）,2组患者均无异体输血。术中生命体征均平稳,无心、肺、脑、肾相关并发症发生。结论 AHH联合控性降压对鼻内镜手术血液保护效果好,安全性高。

Blood-saving effect of acute hypervolumic hemodilution combined with controlled hypotension in patients undergoing nasoendoscopic operations.

Objective To evaluate the blood-saving effect of acute hypervolumic hemodilution（AHH） combined with controlled hypotension in patients undergoing nasoendoscopic operations.Methods Seventy ASA I or II patients aged 20 ~ 55 years old who received nasoendoscopic operation were divided randomly into group AHH＋CH（n = 35） and group CH（n = 35）.Hypotension of all patients were controlled with Nitroglycerine at 0.3 ~ 1μg /（kg·min） after the beginning of operation.The MAP was controlleded at 60 ~ 65mmHg within 10 ~ 15min,and maintained till the accomplishment of operation.Twenty mg Aslor were given intravenously to the patients if the heart rate exceeded 100beats / min.In addition,all the patients of group AHH＋CH were transfused with 6% HES 130 /0.4 at 50 / min and 15ml / kg.The data of HR,MAP,CVP and SPO2,blood loss,urine output,operation time and blood transfusion were recorded.Results All the operations were steady,no blood transfusion occurred,no cardiac,pulmonary,brain and renal complications were occurred.The operation time of group AHH＋CH was shorter than that of group CH,as for blood loss,decreased significantly,while urine output,increased significantly（P〈0.01）.Conclusion AHH combined with CH had significant blood-saving effect in the nasoendoscopic operations,this was a safe messure used in nasoendoscopic operations.