急性等容血液稀释联合控制性降压在脊柱手术中的应用

发布时间：2018-02-08 16:05

本文关键词： 急性等容血液稀释控制性降压脊柱手术异体输血　出处：《广西医科大学》2014年硕士论文　论文类型：学位论文

【摘要】：目的观察急性等容血液稀释(ANH)联合控制性降压(CH)应用于脊柱手术的效果和安全性。方法对我院脊柱骨病外科2013年4月至2013年9月择期全麻下行脊柱复杂手术术中行ANH联合CH患者55例(观察组)及2012年10月至2013年3月脊柱复杂手术术中单纯行CH的55患者(对照组)进行总结比较。观察组于麻醉诱导后按Gross公式行ANH至Hct为0.30,两组均于手术开始时泵注硝酸甘油复合艾司洛尔行控制性降压至MAP为60～70mmHg。两组均在麻醉诱导前(To)、麻醉诱导后CH前(T1)、CH平稳后20min(T2)、手术结束前30min(T3)及术毕即刻(T4)记录MAP、HR；在T0、T2、T4、术后第一天(T5)及出院前(T6)检测Hb、Hct、PLT:在T0、T5时点检测PT、APTT、FIV;在T2、T4时点检测pH.PaC02.Pa02.BE. HCO3-、Sa02、Glu；记录手术时间、术中输液量、出血量和尿量,术中及术后异体输血量、输血例数、术后24h引流量及不良事件发生情况。结果①两组患者在T1、T2、T3时点的MAP均较T0明显降低(P0.05)；两组在T1、T2时点的HR均较T0显著降低(P0.05)。术中同一时点两组间MAP、HR的差异无统计学意义(P0.05)。②与对照组相比,观察组术中输液量及尿量显著增加,术中异体输血量及异体输血例数显著降低(P0.05)；两组术中出血量及术后异体输血量、输血例数、引流量无显著差异(P0.05)。③与T0时点比较,两组患者术中、术后各时点Hb、Hct均明显降低(P0.05)；除T2时点外,其余各时点两组间Hb、Hct均无明显差别(P0.05)。④与T0比较,T5时点观察组PT明显延长,FIB明显减少,APPT无明显改变。结论与单独行控制性降压比较,中度急性等容血液稀释联合控制性降压可显著降低脊柱手术患者术中异体输血量和异体输血率,术中血流动力学稳定,未导致具有临床意义的凝血功能异常,是脊柱手术较为理想的血液保护方法。
[Abstract]:Objective to observe the efficacy and safety of acute normovolemic hemodilution (ANH) combined with controlled hypotension (Ch) in spinal surgery. Methods ANH combined with Ch was performed in 55 patients with spinal complex surgery under elective general anesthesia from April 2013 to September 2013 in our hospital (observation group) and from October 2012 to October 2012 to October 2012 to October 2012. 55 patients with Ch (control group) were compared. The observation group received ANH to Hct 0.30 according to Gross formula after anesthesia induction, and both groups received controlled hypotension with nitroglycerin combined with esmolol at the beginning of operation to MAP 600.70mmHg. MAPHRs were recorded before anesthesia induction, 20 mins after anesthesia induction, 20 min after anesthesia induction, 30 min before operation and 30 min after operation, and immediately after operation; HbHctT5) and HbHctT6) were recorded at T0 T2T2, T5) and pre-discharge T6); PTT was detected at T0 T5; pH.PaC02.02.BE. HCO3-T02Glu. at T2T4. Intraoperative transfusion volume, blood loss and urine volume, intraoperative and postoperative allogeneic blood transfusion, blood transfusion cases, postoperative 24 hours drainage and adverse events occurred. Results 1 the MAP of the two groups were significantly lower than that of T0 at T _ 1 / T _ 2T _ 3, and HR at T _ 1 / T _ 2 were significantly lower than that of T _ 0. There was no significant difference between the two groups at the same time during operation (P 0.05.2) compared with the control group. In the observation group, the volume of transfusion and urine volume increased significantly, the volume of allogeneic blood transfusion and the number of cases of allogeneic blood transfusion decreased significantly in the observation group, and there was no significant difference between the two groups in the amount of intraoperative and postoperative blood transfusion, the number of cases of transfusion, and the volume of drainage. In both groups, HbHct was significantly decreased at each time point after operation, except at T2 time point, there was no significant difference between the other two groups. Compared with T0, the PT of observation group at T5 time point significantly prolonged and decreased APPT. Conclusion compared with controlled hypotension alone, moderate acute hemodilution combined with controlled hypotension can significantly reduce the volume of allogeneic blood transfusion and the rate of allogeneic blood transfusion during spinal surgery, and the hemodynamics is stable during operation. It is an ideal blood protection method for spinal surgery.
【学位授予单位】：广西医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R614

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