控制性降压联合自体血回收在脊柱侧弯矫正术中的应用

目的:观察控制性降压(CH)联合自体血回收回输技术应用于脊柱侧弯矫正术的临床效果与安全性。方法:40例脊柱侧弯矫正术病人,随机分成观察组(G组)和对照组(D组),G组手术开始时用硝普钠行CH,维持MAP(65±5)mmHg,并应用自体血液回收机回收回输术野出血。D组常规麻醉。两组术中连续监测HR、MAP、中心静脉压(CVP);记录出血量、异体血输入量及手术时间,并分别于术前、术毕测定Hb、血细胞比容(Hct)及凝血酶原时间(PT)、活化的部分凝血酶原时间(APTT)和纤维蛋白原(FG)。结果:G组失血量(2150±215)ml显著低于D组(2650±265)ml(P<0.05),G组回输洗涤红细胞量(855±83)ml;G组输血量(950±215)ml显著低于D组(2210±345)ml(P<0.05)。两组Hct、Hb术毕较术前降低(P<0.05),两组PT、APTT在术毕均长于术前(P<0.05),而FG低于术前(P<0.05),但均在正常范围。结论:控制性降压联合自体血回收可安全用于脊柱侧弯矫正术,并明显减少术中出血量,术中配合自体血回收回输技术可减少异体输血。

Application of controlled hypotension and auto-blood reclaiming in scoliolosis diorthosis

Objective ：To investigate the safety and efficacy of controlled hypotension and autologous blood salvaging in scoliolosis diorthosis. Methods： Forty patients undergoing scoliolosis diorthosis were divided randomly into two groups with 20 patients in each. Patients in group G received controlled hypotension using sodium nitroprusside, maintaining MAP （65 ± 5） mmHg,and reclaiming of auto-blood. Patients in group D received general anesthesia routinely. Heart rate, MAP and CVP were monitored continuously. The volume of haemorrhage, the volume of homologous transfusion, and operating time were recorded. Hemoglobin （Hb）, haematocrit （Het）, prothrombin time （PT）, partial prothrombin time （PPT） and fibrinogen （FG） were assessed preoperatively and postoperatively. Results：Volume of haemorrhage in group G was significant lesser than that in group D （2150±215） ml vs （2650±265） ml ,P〈0.05）. 855±83 ml of washed red cells was infused to patients in group G. Volume of transfusion in group G was significant lesser than that in group D （950±215） ml vs （2210±345） ml, P〈0.05）]. Values of both Hct and Hb in two groups were decreased postoperatively （P〈0. 05）. Values of both PT and APTT in two groups were longer postoperatively than before operation （P〈0.05）. However, the values of FG in two groups were lower postoperatively compared with that before operation （P〈0.05）. Conclusion：Combination of controlled hypotension and autologous blood salvaging can be used in scoliolosis diorthosis safely. It decreases volume of haemorrhage during operation. It decreases volume of homologous transfusion when combined with autologous blood salvaging.