急性高容量血液稀释复合控制性降压用于全髋置换术的临床观察

目的：探讨急性高容量血液稀释（AHH）与控制性降压复合应用于全髋置换手术的安全性。方法：选择ASAⅠ-Ⅱ级的全髋置换择期手术病人40例，随机分为两组，每组20例，Ⅰ组为AHH复合硝酸甘油控制性降压组，Ⅱ组为对照组。两组病人均行常规手术麻醉，同时给予Ⅰ组病人AHH复合硝酸甘油控制性降压。观察两组病人的术中失血量、输血量、术后24h引流量和输血病人的例数；Ⅰ组病人于AHH前后分别检测HR、CVP和尿量；两组病人分别于AHH前、AHH后、术毕、术后第1d和第7d测定血红蛋白（Hb）、血细胞比容（Hct）、血小板计数（Pc）；分别于AHH前、术后第1d和第7d测定凝血酶原时间（PT）、凝血酶时间（TT）、部分凝血活酶时间（APTT）和纤维蛋白原（FG）。结果：两组病人术中平均失血量、平均输血量、24h引流量及输血例数比较具有显著差异（P〈0．01）；Ⅰ组病人AHH前后HR和CVP无明显区别，AHH后尿量明显高于AHH前（P〈0．01）；两组病人术毕、术后1d及术后7d的Hb和Hct均明显低于术前水平，但仍然在代偿范围内；两组病人手术前后的凝血机能无明显区别。结论：AHH复合控制性降压可安全用于全髋置换手术病人，可明显减少此类病人的术中失血量和异体血需求量。

CLINICAL OBSERVATION ON APPLICATION OFAHH COMBINED CONTROLLED HYPOTENSION ON TOTAL HIP REPLACEMENT OPERATION

Objective：To investigate the security of applying acute hypervolemic hemodilution （AHH） combined controlled hypotension （CH） on total hip replacement.Methods：40 ASA Ⅰ - Ⅱ total hip replacement patients were used in this study and randomly divided into 2 groups,each group had 20 patients： Ⅰ group was AHH＋CH group, Ⅱ group was control group. During operation,the patients in 2 groups were all routinely anesthetized;in addition, the patients in Ⅰ group were also administrated AHH combined nitroglycerin CH. Volume of blood loss, blood transfusion and draining in 24-hour, also the number of blood transfusion patients were observed;The HR,CVP and urinary production of patients in Ⅰ group before and after AHH were respectively recorded;Hb, Hct,PC and the function of blood clotting of all the patients were measured before and after AHH,at the end of operation, ld and 7d after operation.Results：There had obvious difference between the 2 groups about volume of blood loss,blood transfusion and draining in 24-hour, and the number of blood transfusion patients （P 〈 0.01）.There had no obvious difference about HR and CVP of patients in Ⅰ group before and after AHH;but the urinary production of patients in Ⅰ group after AHH was obviously higher than that before AHH （P 〈 0.01）.The Hb and Hct of patients in these 2 groups after operation were all lower than that before operation,but still in compensatory zone. There had no obvious difference about the function of blood clotting of patients in these 2 groups before and after operation.Conclusions：AHH combined CH can be securely used for total hip replacement patients and can effectively reduce blood loss and blood transfusion during operation.