急性高容量血液稀释联合利喜定控制性降压对手术患者出血量、输血量及血流动力学的影响研究

目的观察急性高容量血液稀释（AHH）联合利喜定控制性降压（CH）对手术患者出血量、输血量和血流动力学的影响。方法选择静吸复合全身麻醉下脊柱外科胸、腰椎内固定手术60例,随机分为3组,每组20例。Ⅰ组为对照组,Ⅱ组为AHH组,Ⅲ组AHH联合利喜定CH。分别于AHH前（T0,Ⅰ组为麻醉诱导后）、AHH后30min（T1,Ⅰ组为麻醉诱导后30min）、AHH后60min（T2）记录平均动脉压（MAP）、中心静脉压（CVP）、心率（HR）、血红蛋白（Hb）、红细胞压积（Hct）等指标,记录术中出血量、尿量、输血量。结果组内及组间比较,3组患者HR差异无统计学意义（P〉0.05）,组内与T0相比,Ⅱ组CVP增高和Ⅲ组MAP降低有统计学意义（P〈0.01）;与Ⅰ组、Ⅱ组相比,Ⅲ组失血量、输血量的减少有统计学意义（P〈0.01）。结论AHH联合利喜定CH能减少术中患者失血量和输血量,不影响血流动力学。

Clinical application of acute hypervolemic hemodilution combined with controlled hypotension induced by urapidil

Objective To observe the effects of acute hypervolemic hemodilution（AHH） combined with urapidil in-duced controlled hypotension on hemodynamics,blood loss and blood transfusion in surgery.Methods Sixty ASAⅠ～Ⅱpa-tients undergoing elective operation of spinal surgery were randomly divided into controlled group（Ⅰ,n=16）,AHH group（Ⅱ,n= 16） and AHH combined with urapidil induced controlled hypotension group（Ⅲ,n=16）.mean aortic pressure（MAP）,central venous pressure（CVP）,heart rate（HR）,haematocrit（Hct）,hemoglobin（Hb） were recorded before hemodiluion（T0,after induction of anes-thesia）,30min after hemodilution（T1,in groupⅠ,the time point was 30min after induction of anesthesia）,and 1h after hemodilu-tion（T2）.Urine output,blood loss,and blood transfusion of each operation were recorded.Results There was no significant change in HR（P〉0.05）.CVP increased significantly in groupⅡ（P〈0.01）.MAP in group Ⅲ was significantly lower than in groupⅠand groupⅡ（P〈0.01）.Blood loss and blood transfusion significantly decreased in groupⅢ compared with groupⅠand groupⅡ（P〈0.01）.Conclusion AHH combined with controlled hypotension induced by urapidil can decrease blood loss,reduce transfusion of homologous blood,make hymodynamic stable.