摘要
目的 探讨术前急性高容血液稀释联合控制性降压对腰椎手术病人肾小球功能和内环境的影响。方法 将30例腰椎骨折椎板减压、切复内固定病人随机分为两组,术前急性高容血液稀释联合术中硝普钠控制性降压组(联合组)和单纯硝普钠控制性降压组(对照组),每组15例。测定联合组插管后稀释前(T0)、稀释后降压前(T1)、降压后30min(T2)和停降压后30min(T3)四个时间点,对照组插管后降压前(T1)、降压后30 min(T2)和停降压后30 min(T3)三个时间点动脉血K+、Na+、Ca2+、Cl-浓度和血气分析以及血浆β2-微球蛋白(β2-MG)的变化。结果 pH值:联合组T1-3较T0降低(P<0.01),而且低于对照组(P<0.05),T1、T2和T3之间无明显改变(P>0.05)。两组K+、Na+、Ca2+、Cl-和BE的变化比较无统计学意义(P>0.05)。联合组β2-MGT1低于T0(P<0.05);对照组T2较T1升高(P<0.05),而且高于联合组(P<0.05)。结论 硝普钠控制性降压可降低肾小球滤过率,术前急性高容血液稀释可以改善术中控制性降压对肾小球滤过率的影响,对内环境无明显影响。
Objective To investigate the effects of acute hypervolemic hemodilution (AHH) combined with controlled hypotension (CH) on plasmaβ2-microglobulin (used as a measure of glomerular filtration rate), blood gases and electrolytes in patients undergoing spinal surgery. Methods Thirty ASA Ⅰ-Ⅱ patients aged 18-61 yrs, weighing 45-70 kg scheduled for spinal surgery were randomly divided into 2 groups : group Ⅰ AHH + CH ( n = 15) and group Ⅱ CH alone ( n = 15) . The patients were unpremedicated. Anesthesia was induced with midazolam 2-3 mg, fentamyl 0.2 mg and proopofol 2.0 mg·kg-1. Intubation was facilitated with vecuronium 0.1 mg·kg-1. The patients were mechanically ventilated after tracheal intubation and PETCO2 was maintained at 35-45 mm Hg. Anesthesia was maintained with isoflurane 1.2-1.6% and intermittent i. v. boluses of vecuronium. Radial artery was cannulated and Swan-Ganz catheter was placed via internal jugular vein after induction of anesthesia. In group Ⅰ (AHH+CH) patients received 6% HAES 200/0.5 20 ml·kg-1 and lactated Ringer's solution 20 ml·kg-1 at a rate of 50 ml·min-1 after placement of S-G catheter. Intra-operative blood loss was replaced with equal volume of 6% HAES 200/0.5. Blood was transfused to maintain Hct > 20% . In both groups CH was induced with infusion of 0.01% sodium nitroprusside (NTP) to maintain MAP at 55-65 mm Hg. MAP, HR, CVP cardiac output were continuously monitored. Arterial blood samples were taken before (T0 ) and after AHH (T1 ) , 30 min after CH was induced (T2 ) and 30 min after tennination of CH (T3 ) for blood gas analysis and determination of plasma levels of electrolytes and β2-microglobulin.Results The two groups were comparable with respect to the demographic data including age, body weight and height. In group Ⅰ pH was significantly decreased after AHH and CH (T1-3) compared to the baseline (T0 ) and was significantly lower than that in group Ⅱ . There was no significant difference in plasma K+ , Na+ , Ca2+ , Cl- and BE between the two groups. Plasm
出处
《中华麻醉学杂志》
CAS
CSCD
北大核心
2004年第10期795-797,共3页
Chinese Journal of Anesthesiology
