摘要
目的探讨急性高容量血液稀释(AHH)联合控制性降压和自体血回输对脑膜瘤的临床效果与安全性。方法选取2012年4月至2017年12月临汾市中心医院神经外科收治的40例择期脑膜瘤手术患者,参考随机数字表法分成观察组和对照组各20例。观察组全麻诱导后30 min内输入琥珀酰明胶15 ml/kg。手术开始时用乌拉地尔行控制性降压,维持平均动脉压(65±5)mm Hg,并用自体血液回收仪回收并回输术野出血。对照组除未行控制性降压外,其余操作均同观察组。两组术中连续监测心率、平均动脉压、中心静脉压;记录出血量、异体血输入量及手术时间,并分别于AHH前后、术毕测定血红蛋白、血细胞比容、pH值、碱剩余值。结果观察组失血量[(837±245)ml]和自体血回输量[(405±123) ml]均低于对照组[(1 197±295) ml]和[(593±247) ml](P<0. 01)。两组血细胞比容、血红蛋白在AHH后和术毕较AHH前降低(P<0. 01),两组各时点pH值、碱剩余值无明显改变。观察组未输入异体血,对照组5例输入去白悬浮红细胞2 U,5例输注新鲜冰冻血浆400 ml。两组均未发生创面异常出血、肺水肿及心衰等并发症。结论 AHH联合控制性降压可安全用于脑膜瘤手术,明显减少术中出血量,术中配合自体血回输技术可减少输血反应。
Objective To observe the clinic effect and safety of acute hypervolemic hemodilution(AHH)combined with controlled hypotension(CH)and autologous blood transfusion in the surgery of meningiomas.Methods Forty patients who receiving meningioma surgery in authors’affiliated hospital from April2012to December2017were randomly divided into the observation group(group A)and the control group(group C).Group A was performed with15ml/kg succinylated gelatin30minutes after anesthesia induction.At the beginning of the operation,uradil was used for CH.MAP was controlled around(65+5)mmHg.Autologous blood transfusion was used to recover the intraoperative bleeding.The operations of group C were the same as group A,except CH.Heart rate,mean arterial pressure and central venous pressure were monitored in the two groups.Operation time,the amount of bleeding,autologous and allogeneic blood transfusion volumes during operative were recorded.Hb,Hct,pH and base excess(BE)values were detected before and after AHH as well as postoperation.Results The blood loss(837±245)ml and autologous blood transfusion volume(405±123)ml in group A were significantly lower than those in group C(1197±295)ml and(593±247)ml(P<0.01).Hct and Hb in the two groups were decreased after AHH and postoperation than that before AHH(P<0.01).pH and BE in the two groups had no obvious change at each time points.Group A was not transfused allogeneic blood.Five patients in group C were transfused with2U dewhite suspended red blood cells(RBC).Five patients were transfused with400ml fresh frozen plasma.There were no complications such as pulmonary edema,heart failure and abnormal wound bleeding occurred in both groups.Conclusions AHH combined with CH can be safely used in the surgery of meningiomas and significantly reduced the blood volume during the operation.Autologous blood transfusion can reduce or even avoid allogeneic transfusion reaction intraoperatively.
作者
班炜军
田丽会
程宇宏
BAN Weijun;TIAN Lihui;CHENG Yuhong(Department of Anesthesiology,Linfen Central Hospital,Linfen 041000,China)
出处
《中国肿瘤外科杂志》
CAS
2018年第6期385-388,392,共5页
Chinese Journal of Surgical Oncology
关键词
脑膜瘤
血液稀释
外科手术
降压
控制性
自体血回收
Meningioma
Hemodilution
Surgical procedures,Operative
Hypotension,Controlled
Autologous blood salvage
