急性高容量血液稀释联合右美托咪啶、硝酸甘油控制性降压在脊柱侧弯矫正术中的应用

目的观察急性高容量血液稀释联合右美托咪啶、硝酸甘油控制性降压应用于脊柱侧弯矫正术的临床效果与安全性。方法将40例脊柱侧弯矫正术患者随机分成实验组和对照组,每组20例。全凭静脉麻醉。实验组采用急性高容量血液稀释联合右美托咪啶、硝酸甘油控制性降压,对照组常规补液。2组术中连续监测心率(HR)、平均动脉压(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、术毕测定血红蛋白(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)。按Fromme评分法进行术野质量评分,记录拔管时间、苏醒期不良反应。结果实验组失血量、输血量显著低于对照组(P<0.05)。2组Hct、Hb术毕均较术前降低(P<0.05),2组PT、APTT在术毕均长于术前(P<0.05),而FG则低于术前(P<0.05),但均在正常范围。2组均无肺水肿、心衰及创面异常出血等并发症。手术中实验组Fromme评分低于对照组(P<0.05)。2组停药后拔管时间差异无统计学意义,实验组苏醒期不良反应发生率低于对照组。结论急性高容量血液稀释联合右美托咪啶、硝酸甘油控制性降压在脊柱侧弯矫正术中的应用安全有效。

Application of controlled hypotension with acute hypervolemic hemodilution combined with dexmedetomidine and nitroglycerin in the process of rachilysis

Objective To observe the efficacy and safety of controlled hypotension with acute hypervolemic hemodilution combined with dexmedetomidine and nitroglycerin in the process of rachilysis.Methods 40 patients with rachilysis were randomly divided into the experimental group(n=20) and the control group(n=20).All the patients were treated with intravenous anesthesia.Experimental group was treated with acute hypervolemic hemodilution combined with dexmedetomidine and nitroglycerin for controlled hypotension,while the control group was treated with conventional fluid infusion.HR,MAP and CVP were continuously monitored between two groups during the operation,and the amount of bleeding,homologous transfusion quantity and operation time were recorded as well.Hb,hematocrit(Hct) and prothrombin time(PT),activated part of prothrombin time(APTT) and fibrinogen(FG) were measured before and after operation.Score of operative field quality were assessed according to Fromme method.Extubation time and adverse reactions in revival period were recorded.Results The loss of blood and the amount of blood transfusion in the experimental group was significantly lower than the control group(P<0.05).Hct and Hb in the preoperative period in both groups were lower than that of the postoperative period(P<0.05).PT and APTT in the postoperative period in both groups were obviously longer than that of the preoperative period(P<0.05),and FG was lower than the preoperative period(P<0.05),but those were all in normal range.No patient had complications such as pulmonary edema,heart failure and abnormal bleeding happens in both groups.Intraoperative Fromme score in the experimental group was lower than control group(P<0.05).There was no significant different between two group in the aspect of extubation after drug withdrawal.Incidence rate of adverse reactions in revival period in the experimental group was lower than the control group.Conclusion Application of controlled hypotension with acute hypervolemic hemodilution combined with dexmedetomidine and nitroglycerin in the process of rachilysis is safe and effective.