急性高容量血液稀释在骨科手术中应用的可行性研究

目的:探讨硬膜外复合全身麻醉下行急性高容量血液稀释在骨科手术中应用的可行性。方法:选取ASAⅠ或Ⅱ级择期行骨科手术患者28例,随机分为两组:AHH组(急性高容量血液稀释组)和C组(对照组)。麻醉前补充禁食所失液体量乳酸林格液6~8ml/kg,局麻下行右桡动脉穿刺置管监测血压,右侧颈内静脉穿刺置管。采用硬膜外阻滞复合全身麻醉,待硬膜外阻滞起效后,AHH组开始血液稀释,快速输入6%羟乙基淀粉20ml/kg,速率50ml/min,对照组常规输液。同时硬膜外注入1.33%利多卡因+0.167%地卡因10ml初始剂量后,开始全麻诱导,术中维持呼气末异氟醚浓度稳定于1.2%左右,术中连续监测收缩压(SP)、舒张压(DP)、平均动脉压(MAP)、心率(HR)、脉搏血氧饱和度(SpO2)、中心静脉压(CVP)、心电图和呼气末二氧化碳分压。分别记录术前(T0)、稀释后15min(T1)、术毕(T2)的MAP、HR、CVP、电解质值和血糖值,以及术前和术后第1d(T3)Hb、Hct。记录术中总出血量、输血量等。结果:AHH组血液稀释后CVP有所增高,但在正常范围内。与C组相比,AHH组患者的MAP、HR较平稳。AHH组在血液稀释后的Hct、Hb明显低于术前水平,术后第1d基本恢复正常。与C组相比,AHH组患者术中输液量、尿量明显增多,异体输血量降低。与术前相比,两组患者的血糖水平在T1、T2增高(P<0.05),各时点血清K+、Na+、Cl-含量差异无统计学意义(P>0.05)。结论:在硬膜外阻滞复合全身麻醉下的骨科手术中行急性高容量血液稀释,血液动力学及内环境稳定,安全有效,切实可行。

Feasibility of administering acute hypervolemic hemodilution on patients undergone bone surgery

Objective:To investigate the feasibility of administering acute hypervolemic hemodilution(AHH)on patients undergone bone surgery under general anesthesia combined with continuous epidural block.Methods:Twenty-eight ASA class Ⅰ or Ⅱ patients undergone elective bone surgery under general anesthesia combined with continuous epidural block were enrolled in this study.The patients were randomized into two groups:AHH group(acute hypervolemic hemodilution group)and C group(control group),with 14 cases in each one.Lactated Ringer solution was infused at 6～8 ml/kg before anesthesia.After correct placement of epidural was confirmed,radial artery were cannulated for BP monitoring and right internal jugular vein was inserted into monitor CVP,BP,ECG,SpO-2 and P-{ET}CO-2 were continuously monitored before and during anesthesia.After a mixture of 1.33% lidocaine with 0.167% dicaine 10 ml was injected via the epidural cather.AHH group was then conducted with 6% hydroxyethyl starch(HES)20 ml/kg infused iv at 50 ml/min.Control group was transfused commonly.Anesthesia was induced with fentanyl 2 μg/kg,midazolam 0.1 mg/kg and propofol 1.5 mg/kg.Tracheal intubation was facilitated with rocuronium 0.6 mg/kg and anesthesia was maintained with isoflurane.After induction,the end-tidal isoflurane concentration was maintained at ±1.2%.The MAP,HR,CVP,electrolyte and blood sugar(BS)were determined before AHH(T0),at 15 min(T-1)and the end of operation(T-2).The determination of Hct and Hb were recorded in the first day before and after operation(T-3).The volume of infusion,blood loss and blood transfusion were measured during operation.Results:After hemodilution,the CVP in AHH group was increased,but in normal range.Compared with group C,MAP and HR in AHH group were maintained stable.Hct and Hb in AHH group after hemodilution were decreased in comparison with pre-operation.The amount of transfusion and urinary production during the operation in AHH group were increased in comparison with group C.Blood sugar level in both groups at T-1 and T-2 was significantly higher than that at T-0(P<0.05).There showed no significant differences in the serum electrolyte level(P>0.05).Conclusion:Acute hypervolemic hemodilution(AHH)can be used safely during operation of orthopaedics under general anesthesia combined with continuous epidural block in terms of hemodynamic change.