摘要
【目的】观察琥珀酰明胶急性高容量血液稀释（AHH）复合瑞芬太尼控制性降压在围术期血液保护中的作用。[方法]40例ASAI-Ⅱ级拟行择期手术（出血量估计大于血容量的15％）的病人，随机分为观察组（I组）和对照组（Ⅱ组），每组20例。均采用全麻，I组于切皮前行AHH，按15mL／kg、50mL／min输入琥珀酰明胶。AHH开始后持续泵入瑞芬太尼0．05-2μg／（kg·min）行控制性降压。Ⅱ组常规输液。记录气管插管后或AHH前（T1）、AHH结束即刻或手术开始时（T2）、AHH后或手术开始后60min（T3）、术毕（T4）的动脉凝血指标、乳酸浓度及术中出血量和输血量。【结果】I组病人失血量、输血量和输血例数明显少于Ⅱ组（P〈0．05）；两组T2-T4时凝血酶原时间（PT）和凝血活酶时间（APTT）较T1时均有所延长，但差异无统计学意义，各时点的两组间的差异亦无统计学意义；I组T2-T4时红细胞比客（Hct）较T1时下降（P〈O．05），T3、T4时Hct下降幅度I组大于Ⅱ组（P〈0．05）；两组动脉血乳酸浓度无明显变化。【结论】琥珀酰明胶AHH复合瑞芬太尼控制性降压用于失血量大的手术病人可以减少术中出血量，减少输血，不影响凝血功能和组织器官氧供，可安全用于围术期血液保护。
[Objective] To observe the effects of Gelofusine acute hypervolemie hemodilution（AHH） combined with remifentanil controlled hypotension（CH） on hemodynamies, tissue perfusion, blood loss and blood transfusion in surgery. [Methods] Forty ASAI-Ⅱ patients undergoing elective operation of spinal or orthopedics surgery were randomly divided into AHH combined with CH group（group I, n =20） and control group（group Ⅱ, n =20）. In group I, AHH was carried out after anesthesia induction. Gelofusine was transfused at 15ml/kg and 50ml/min, and remifentanil was transfused at 0.05 - 2μg/（kg · min） with MAP altering between 60 and 65 mmHg. Conventional saline was transfused in group Ⅱ. MAP, CVP, HR, SpO2, PT, APTT, Lac and Hct were recorded before AHH （T1 ,the time after induction of anesthesia in group Ⅱ）, at once after AHH（T2, the time before skin incision in group Ⅱ）, at 1h after AHH（T3, the time lh after skin incision in group ID and at the end of the operation（T4 ）. Urine output, blood loss and blood transfusion were recorded during operation. [Results] In group I, MAP was obviously lower than preoperation（ P （0.01） and group Ⅱ（ P （0.05）, and was higher than group Ⅱ when controlled hypotension ceased. There was no mush variation in HR and blood lactate. There was an evident rise of CVP in group I（ P 〈01 05）, and it was lower in group Ⅱ than in group I（ P （0. 05）. Hct decreased evidently after AHH in both groups and was lower in group 1（ P 〈0. 05）. PT and APTT at T2 -T4 were more extended than T1 in both groups, but there was no statistical significance. Blood loss and blood transfusion were significantly lower in group Ithan those in group Ⅱ（ P 〈0. 05）. [Conclusion] Gelofusine AHH combined with controlled hypotension induced by remifentanil can make hemodynamic stable, decrease blood loss and reduce transfusion of homologous biood, and has no adverse effect on tissue perfusion and coagulation function. It is safe for perioperative blood
出处
《医学临床研究》
CAS
2009年第5期767-769,共3页
Journal of Clinical Research
基金
湖南省娄底市科技局基金资助项目[编号：娄财技指（2008）562]
关键词
血液稀释
血压
手术中护理
hernodilution
blood pressure intraoperative care
