每搏量变异度为目标导向行急性超容血液稀释技术在脊柱肿瘤手术中的应用

  目的  探索以每搏量变异度（stroke volume variation，SVV）为目标导向行急性超容血液稀释（acute hypervolemic hemodilution，AHHD）在脊柱肿瘤手术中减少失血量和输血量的有效性和安全性。  方法  选取2020年1月至2021年10月于四川省医学科学院·四川省人民医院收治的脊柱肿瘤患者40例，随机分为A组和B组，每组20例。A组行AHHD术中保持SVV≤7%， B组行AHHD术中保持SVV≥13%。记录血液稀释前（T0）、血液稀释后（T1）、出血500 mL时（T2）、出血1 000 mL时（T3）、手术结束后30 min（T4）各时间节点血气分析结果各时间点血气分析结果，局部脑氧饱和度（regional cerebral oxygen saturation，rSO₂）以及血流动力学指标；术前1 d、术后1、3、5 d采用MMSE评分。  结果  术中两组间失血量差异无统计学意义（P>0.05）；术中A组总输液量、尿量分别多于B组，输血量、输血率较B组明显降低（P<0.05）。与A组比较，B组患者T3时间点HR增加、MAP下降、Lac升高、rSO₂降低（P<0.05）；B组术后1 d的MMSE评分较A组降低，认知功能障碍发生率高于A组（P<0.05）。  结论  SVV≤7%目标导向行AHHD能减少脊柱肿瘤手术中的输血量和输血率，血流动力学更稳定，降低术后认知功能障碍的发生率。 

Application of acute hypervolemic hemodilution targeting stroke volume variation in patients undergoing spinal tumor surgery

  Objective  To assess the efficacy and safety of acute hypervolemic hemodilution (AHHD) targeting stroke volume variability (SVV) in reducing blood loss and transfusion volume in patients who underwent spinal tumor surgery.   Methods  Forty patients with spinal tumor enrolled in Sichuan Academy of Medical Sciences & Sichuan Provincial People’s Hospital from January 2020 to October 2021 were randomly categorized into groups A and B, 20 cases each. Patients in group A received AHHD with SVV≤7%, and those in group B received AHHD with SVV≥13%. Blood gas analysis results, regional cerebral oxygen saturation (rSO₂) levels, and hemodynamic indexes at before AHHD(T0), after AHHD (T1), bleeding 500 mL (T2), bleeding 1 000 mL (T3), and 30 min after the surgery (T4) were recorded. The mini-mental state examination (MMSE) scores on the day before surgery and on days 1, 3, and 5 postoperatively were recorded.   Results  There was no significant difference in blood loss volume between both the groups (P>0.05). During surgery, total infusion volume and urine volume were higher in group A than in group B, and blood transfusion volume and rate were lower in group A than in group B (P<0.05). Compared with group A, the heart rate (HR) and lactate level increased and mean arterial pressure (MAP) and rSO₂ decreased in group B at T3 (P<0.05). The MMSE scores on day 1 postoperatively were lower in group B than in group A, and the incidence of cognitive dysfunction was higher in group B than in group A (P<0.05).   Conclusions  Target-oriented AHHD with SVV≤7% can decrease the blood transfusion volume and rate during spinal tumor surgery, stabilize hemodynamics, and reduce the incidence of postoperative cognitive dysfunction.