控制性降压联合急性高容量血液稀释在脊柱外科手术中的应用

目的：观察控制性降压联合急性高容量血液稀释用于脊柱手术对减少术中出血量和输血量的影响。方法：选择美国麻醉医师协会（ASA）的标准Ⅰ～Ⅱ级行胸、腰椎椎管减压内固定术的患者36例，采取双盲法随机分为A组和B组，每组18例。A组为对照组，B组为控制性降压联合急性高容量血液稀释组。麻醉诱导后B组于术前行急性高容量血液稀释，术中静脉泵输注硝酸甘油使平均血压（MBP）维持在70mmHg（1mmHg=0．133kPa）左右至手术结束。术中连续监测循环变化，比较两组患者的出血量和输血量，观察有无反跳性高血压发生等。结果：手术过程中B组在出血量和输血量上明显低于A组，且无反跳性高血压发生。结论：控制性降压联合急性高容量血液稀释用于脊柱手术可以有效减少术中出血量和输血量。

Use of controlled hypotension combined with acute hypervolemic hemodilution in spinal surgery

Objective： To observe intraoperative blood loss and blood transfusion used by the controlled hypotension combined with acute hypervolemic hemodilution in spinal surgery. Methods： 36 cases of patients with thoracic-lumbar spinal decompression and internal fixation were double-blind randomized into group A and group B（n = 18 cases）by American Society of Anesthesiologists （ASA） standard I -I level. Croup A was the control group while group B was the group of controlled hypotension combined with acute hypervolemic hemodilution. After anesthesia induction, group B was given acute hypervolemic hemodilution before surgery, and the mean blood pressure （MBP） maintained at about 70mmHg （1 mmHg =0. 133kPa） to the end of surgery by intraoperative intravenous pump infusion of nitroglycerin. Intraoperative circulatory changes were continuous monitored, the amount of bleeding and blood transfusion were compared between the two groups and the rebound hypertension were observed. Resuits：Intraoperative blood loss and blood transfusion in group B was significantly lower than in group A, and no rebound hypertension happened in group B. Conclusion： The controlled hypotension combined with acute hypervolemic hemodilution in spine surgery can be effective in reducing intraoperative blood loss and blood transfusion.