摘要
目的 探讨围术期急性高容量血液稀释 (AHH)联合控制性降压的临床效果。方法 总结 40例食管癌、贲门癌手术病人 ,随机分为AHH联合控制性降压组 (Ⅰ )和对照组 (Ⅱ )各 2 0例。两组术中监测MAP、CVP、HR ,并在术前、AHH1h及术后 2 4h测定Hb、Hct、PLT ,记录术中出血量、输液量和输血量。结果 Ⅰ组MAP显著低于术前 (P <0 0 1)和Ⅱ组 (P <0 0 1) ,AHH后两组CVP均明显升高 (P <0 0 1) ,但Ⅰ组低于Ⅱ组 (P <0 0 1)。Hb、Hct较术前水平明显降低、但均仍在正常代偿范围 ;Ⅰ组术中出血量明显少于Ⅱ组 ,输血量Ⅱ组 9例 ,Ⅰ组未输血。两组HR无明显变化。结论 AHH联合硝酸甘油控制性降压 ,可明显减少手术中出血量 ,减少输血 ,一定程度上避免了输异体血的不良反应和血源浪费 ,对血液动力学影响小。是临床上一种安全有效、简便易行的血液保护方法。
Objective To evaluate the clinical effect of controllable blood pressure depression in combination with acute hypervolmic hemodilutien (AHH) during operation. Methods 40 patients with esophageal or cardiac carcinomas were randomly divided into controllable blood pressure depression in combination with AHH group(group I)and control group (group Ⅱ), each group containing 20 patients. MAP, CVP and HR were monitored during operation. And Hb,Hct and Plt were aslo monitored before operation, 1h after AHH and 24h after operation. The volume of solution infusion,blood loss and blood transfusion were recorded during operation. Results MAP after operation in group I was significantly lower than that before operation in groups I and Ⅱ(P<0.01). CVP in the both groups obviously elevated after AHH, and CVP in groupⅡ was significantly higher than that in group I (P<0.01). Hb and Hct significantly decreased after operation, but were still within normal compensation range. The volume of blood loss in group I was less than that in group Ⅱ. Blood transfusion was performed in 9 patients in group Ⅱ, and none in group I. HR was comparable between the two groups. Conclusion Controllable blood pressure depression using glonoin in combination with AHH could reduce blood loss and blood transfusion during operation, and avoid the waste of blood resource and the side effect of blood transfusion at some extent. It affected hemodynamics slightly, and was a safe, effective and simple means of saving blood resource.
出处
《中国医师杂志》
CAS
2004年第10期1349-1351,共3页
Journal of Chinese Physician
