急性高容量血液稀释技术在胸腰椎结核病灶清除植骨融合内固定术中的应用

目的探讨急性高容量血液稀释(AHH)用于减少胸腰椎结核病灶清除植骨融合内固定术中输血的有效性和安全性。方法择期胸腰椎结核病灶清除植骨融合内固定术患者30例随机分为试验组(V组)和对照组(C组),其中V组输注6%羟乙基淀粉液,C组输注乳酸钠林格液。测定手术不同时刻的血液动力学指标,并记录术中输血量、输液量、尿量及出血量;分别于术前后测定红细胞压积(Hct)和血红蛋白(Hb)。结果 V、C组患者出血量和输液量之间差别没有统计学意义(P>0.05),V组输血量与C组相比较低(P<0.05);V组MAP与HR维持较C组平稳;两组CVP在稀释后均明显升高,C组Hct和Hb在术毕和术后明显低于基础值及V组,但均在正常范围。结论在全麻下行胸腰椎结核病灶清除植骨融合内固定手术前行急性高容量血液稀释能够一定程度上减少术中出血量及输血量,减少输血并发症。

Applications of Acute Hypervolemic Hemodilution during Curettage of Tuberculous Focus for Thoracic and Lumbar Bone Replacement Setting Surgery

Objective To study the efficient and safety of applications of AHH during curettage of tuberculous focus for thoracic and lumbar bone replacement setting surgery.Methods 30 patients were divided into test group(V group) and control group(C group).6% hydroxyethyl starch was used in V group,while lactated ringer solution used in C group.Hemodynamic indexes in different time were measured,and intraoperative blood transfusion,fluid volume,urine output and bleeding were recorded.Hct and Hb were measured before and after operation.Results Both patient groups blood loss and blood transfusion levels were negligible(P>0.05),but V group’s blood filtering levels were noticeably lower than C group’s(P<0.05);MAP and HR in V group were more stable than those in C group;both groups CVP were noticeably higher after hemodilution,C group’s pre-operation and post-operation Hct and Hb levels were noticeably lower than V group’s but still in the normal range.Conclusion AHH applied during curettage of tuberculous focus for thoracic and lumbar bone replacement setting surgery could reduce blood loss and blood transfusion,and transfusion complications could be reduced.