急性高容量血液稀释复合控制性降压在脊柱手术中的应用

目的]探讨急性高容量血液稀释（AHH）与控制性降压（CH）复合应用于脊柱手术的安全性.方法]选择ASA Ⅰ-Ⅱ级择期行脊柱手术病人48例,随机分为AHH组（A组,AHH联合CH）和对照组（B组,常规输液）,每组24例.两组病人均行常规手术麻醉,同时给予A组病人6%羟乙基淀粉（130/0.4）复合硝酸甘油CH.观察两组病人的术中失血量、输血量和输血病人的例数;AHH前后心率（HR）、平均动脉压（MAP）和中心静脉压（CVP）;AHH前后和术毕血红蛋白（Hb）、红细胞比容（Hct）、凝血酶原时间（PT）;PT、部分活化凝血酶时间（APTT）和纤维蛋白原（Fg）的变化.结果]两组病人术中平均失血量、平均输血量及输血例数比较具有显著差异（P〈0.01）;两组病人AHH前后HR、MAP和CVP无明显区别,AHH后尿量明显高于AHH前（P〈0.01）;A组病人AHH后及术毕、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只有A组APTT在AHH后时间点较AHH前明显延长（P〈0.05）,其他无明显区别;A组Fg在术毕时间点较AHH前明显下降（P〈0.05）.结论]AHH复合CH可安全用于脊柱手术病人,并可明显减少此类病人的术中失血量和异体血需求量.

Clinical Research on AHH Combined Controlled Hypotension Applied in Spinal Surgery

Objective]To explore the safety of acute hypervolemic hemodilution （AHH） combined controlled hypotension（CH） applied in spinal surgery. Methods] Forty eight ASA Ⅰ-Ⅱ patients undergoing spinal surgery were randomly divided into AHH group（group A, AHH＋CH） and control group（group B, normal liquid transfusion） with 24 in each. During operation, the patients in two groups were all routinely anesthetized. In addition, the patients in group A were also administrated 6% hydroxyethl starch（130/0.4） combined with nitroglycerin. The intraoperative blood loss volume, blood transfusion volume and the number of patients receiving blood transfusion were observed. The heart rate（HR）, mean arterial pressure（MAP） and central venous pressure（CVP） before and after AHH were recorded. Hb, Her, Pt and the function of blood clotting of all the patients were measured before and after AHH and at the end of operation. Results] There were significant differences in the mean blood loss volume, mean blood transfusion volume and the number of patients receiving blood transfusion between two groups（ P 〈0.01）. There was no significant difference in HR, MAP and CVP before.and after AHH between two groups. The urinary volume of patients after AHH was obviously higher than that before AHH （ P 〈0.01）. The Hb and Hct of patients in group A after AHH and operation were lower than those before operation, but they were still in compensatory zone. APTT of patients in group A after AHH was longer than that before AHH（ P 〈0.05）, and other parameters of the function of blood clotting had no obvious difference. Compared with before AHH, the Fg was decreased at the end of operation（ P 〈0.05）. Conelusion]AHH combined CH can be securely used for spinal surgery patients and effectively reduce blood loss, blood transfusion during operation.