急性高容量血液稀释联合控制性降压在俯卧位脊柱手术中应用的临床分析

目的探讨急性高容量血液稀释（AHH）联合控制性降压（CH）在俯卧位脊柱手术中临床效果及安全性。方法选择2011年1月～2013年1月在深圳市第二人民医院骨科进行脊柱手术的72例患者,分为观察组和对照组,每组各36例。两组均采用静吸复合麻醉,观察组应用AHH联合CH;对照组常规补液。比较两组术中失血量、输血量、补液量及尿量;两组诱导前（T0）、AHH后（T1）、手术结束（T2）时的心率（HR）、平均动脉压（MAP）和中心静脉压（CVP）;两组T0、T1、T2和术后1 d（T3）时两组血红蛋白（Hb）含量和血细胞比容（HCT）;两组T0、T2时凝血功能相关指标;由手术医师对两组术野进行Fromme评分,并进行比较。结果①观察组失血量、输血量少于对照组,输液量及尿量均多于对照组,差异均有高度统计学意义（P=0.0000）。②两组各时间点HR比较,差异无统计学意义（P＆gt;0.05）,T1时观察组MAP较T0时降低[（86.9±15.8）mm Hg（1 mm Hg=0.133 kPa）比（68.9±14.1）mm Hg],差异有高度统计学意义（t=5.1000,P=0.0000）,且低于对照组T1时[（68.9±14.1）mm Hg比（85.6±14.4）mm Hg],差异有高度统计学意义（t=5.2773,P=0.0000）;T1、T2时观察组CVP值较T0时升高[（10.8±1.6）、（11.1±2.3）cm H2O比（7.5±1.3）cm H2O（1 cm H2O=0.098 kPa）],差异有高度统计学意义（t=9.6044、8.1757,P=0.0000）,且高于对照组同时相[（10.8±1.6）cm H2O比（6.9±1.4）cm H2O,（11.1±2.3）cm H2O比（8.6±1.7）cm H2O],差异有高度统计学意义（t=11.0064、5.2446,P=0.0000）。③观察组T1时Hb和HCT低于对照组[（99.8±13.9）g/L比（121.6±14.5）g/L,（27.1±3.9）%比（38.7±4.1）%],差异有高度统计学意义（t=6.6115、12.2998,P=0.0000）,观察组T2时Hb低于对照组[（88.8±13.1）g/L比（108.3±14.6）g/L],差异有高度统计学意义（t=5.9647,P=0.0000）,观察组T1、T2、T3时Hb低于T0时[（99.8±13.9）、（88.8±13.1）、（98.6±14

Clinical analysis of application of acute hypervolemic hemodilution with controlled hypotension in spinal operation at prone position

Objective To investigate the effect and safety of acute hypervolemic hemodilution（AHH） combined with controlled hypotension（CH） in spinal operation at prone position. Methods 72 patients with spine surgery at Department of Orthopedics in the Second People＇s Hospital of Shenzhen City, from January 2011 to January 2013, were as the research objects, and they were divided into observation group and control group, with 36 cases in each group. All the patients were treated with intravenous inhalation anesthesia, the patients in the observation group were treated with AHH combined with CH, while the control group was treated with conventional fluid infusion. The blood volume, blood transfusion, fluid intake and urine output of the patients in two groups; before induction（T0）, after AHH（T1）, end of operation（T2） the heart rate（HR）, mean arterial pressure（MAP） and central venous pressure（CVP） of the two groups, blood protein（Hb） content and the hematocrit （HCT） of patients in two groups at T0, T1, T2 and 1 d after operation（T3）; the related indexes of blood coagulation function at T0, T2; the operation doctor underwent Fromme scores of operation field on patients in two groups, and compared those between groups, above all the indexes werer observed and compared. Results ①The blood loss, blood transfusion amount of patients in the observation group were less than those in the control group, the infusion and urine volume were more than those in the control group, the differences were statistically significant（P = 0.0000）. ②There was no statistical difference at each time point HR between the two groups（P〉0.05）; MAP of the observation group at T1 were decreased than that at T0[（86.9±15.8） mm Hg（1 mm Hg = 0.133 kPa） vs（68.9±14.1） mm Hg], the difference was statistically significant（t = 5.1000, P = 0.0000）, and it was lower than that of the control group at T1[（68.9±14.1） mm Hg vs（85.6±14.4） mm Hg], the difference was statistically signifi