摘要
目的观察术中不同血液回输量对血浆胶体渗透压(COP)和肺功能的影响。方法选择符合条件的拟在全身麻醉下行骨科脊柱手术的患者,根据术中出血量和自体血液回输量将患者分成3组:自体血液回输量≤250m L(A组)、自体血液回输量251-500 m L(B组)和自体血液回输量>500 m L(C组)。3组患者均采用气管插管全身麻醉和机械通气:潮气量8 m L/kg、呼吸频率(10-18)次/min、吸/呼比为1∶2。术中监测BP、HR、ECG、Sp O2、CVP、PET CO2、动脉血气、COP和气道峰压。术中对创面的所有血液进行回收和肝素抗凝,然后进行洗涤、离心和回输。术中根据患者的血液动力学变化调整液体入量,所有液体按晶体/胶体比1.5∶1的比例分别给予复方氯化钠和6%的羟乙基淀粉130/0.4氯化钠注射液。术中根据血气分析调整呼吸频率、电解质和酸碱平衡。麻醉诱导前(T0)、麻醉后(T1)、切皮前(T2)、血液回输前(T3)、血液回输后15 min(T4)和手术结束后(T5)分别记录患者的血液动力学变化、呼吸参数变化并计算肺的动态顺应性、监测COP、血气变化并计算肺泡-动脉氧分压差(PA-a DO2)和氧合指数(Pa O2/Fi O2)。结果 1)COP的变化:1)组内比较:A组T1、T2、T3、T4、T5各时点和T0相比无显著变化(P>0.05);B组、C组的T1、T2各时点和对应的T0相比无明显变化(P>0.05),B组、C组T3、T4、T5各时点(B/C:20.7±1.9/18.0±1.8、19.0±2.1/17.3±1.8、19.6±2.4/17.1±2.9)和对应的T0(23.0±2.5/23.1±2.1)相比明显下降(P<0.05)。2)组间比较:T0、T1、T2各时点3组间无明显变化(P>0.05);B组T3、T4、T5(20.7±1.9、19.0±2.1、19.6±2.4)各时点较A组(21.6±2.1、21.3±1.9、22.0±2.2)对应各时点明显下降(P<0.05),C组T3、T4、T5(18.0±1.8、17.3±1.8、17.1±2.9)各时点较相应的A组(21.6±2.1、21.3±1.9、22.0±2.2)和B组(20.7±1.9、19.0±2.1、19.6±2.4)均显著下降(P<0.05)。2)PA-a DO2和Pa O2/Fi O2变化:(1)组内比较:A组的T2、T3、T4、T5各
Objective To observe the volume of intra-operative cell salvage（ ICS） and its corresponding effect on the plasma colloid osmotic pressure（ COP） and pulmonary function of the patient. Methods Patients scheduled for the spinal surgery during general anesthesia were enrolled and divided into 3 groups according to the volumes of blood loss and ICS：Group A（ ICS≤250 m L）,Group B（ ICS 251-500 m L） and Group C（ ICS〉500 m L）. All patients received general anesthesia and mechanical ventilation after intubation（ VT = 8 m L/kg,RR = 10-18/min,I/E = 1 ∶2）. BP,HR,ECG,Sp O2,CVP,PETCO2,blood gas analysis,plasma colloid osmotic pressure（ COP） and the Peak airway pressure were measured and monitored during the surgery. Blood salvage was performed with heparin anti-coagulation and washed,centrifuged and collected using a sterile bag,and then the red blood cells were transfused before the end of surgery. Fluid was infused according to the intra-operative hemodynamics,and the liquids consisted of compound sodium chloride and 6% hyroxyethyl starch 130/0. 4 at the ratio of 1. 5 ∶ 1. Respiration rate,electrolyte and acid-base balance were adjusted based on the blood-gas analysis. The change of hemodynamics,ventilation parameters and COP were measured at the following time points： before anesthesia induction（ T0）,after anesthesia induction（ T1）,before the skin cut（ T2）,before autologous blood transfusion（ T3）,15 min after transfusion（ T4） and the end of surgery（ T5）. Dynamic pulmonary compliance,alveolar arterial blood oxygen difference（ PA-a DO2） and oxygenation index（ Pa O2/Fi O2） were calculated based on the respiration parameters and blood gas analysis.Results 1. COP： Intra-group comparison： For group A,no significant difference was found at any of the time points observed（ P〉0. 05）. For group B and C,COP were significantly decreased at T3,T4,T5（ B/C： 20. 7±1. 9/18. 0±1. 8,19. 0±2. 1/17. 3±1. 8,19. 6±2. 4/17. 1±2. 9）（ P〈0. 05） while no
出处
《中国输血杂志》
北大核心
2017年第11期1253-1258,共6页
Chinese Journal of Blood Transfusion
关键词
骨科手术
血液回收
输血
自体
胶体渗透压
血浆
肺功能
orthopedic surgery
blood salvage
blood transfusion, autologous
plasma colloid osmotic pressure
pulmonary function
