控制性低中心静脉压对脊柱手术患者血管外肺水和失血量的影响

发布时间：2018-03-17 18:53

本文选题：控制性低中心静脉压　切入点：血流动力学　出处：《临床麻醉学杂志》2015年05期 　论文类型：期刊论文

【摘要】：目的观察术中行控制性低中心静脉压(controlled low central venous pressure,CLCVP)对脊柱手术患者血管外肺水(extravascular lung water,EVLW)和失血量的影响。方法 36例择期行腰椎后路椎管减压植骨融合术的患者随机分为CLCVP组(L组)和对照组(C组),每组18例。L组于手术开始后通过限制输液联合静脉输注硝酸甘油使CVP维持在2~4cm H2O,植骨融合完成后迅速扩容使CVP恢复正常。C组常规补液,维持CVP在6~12cm H2O。分别于麻醉诱导后仰卧位(T0)、降压前俯卧位(T1)、CLCVP后30min(T2)、60min(T3)、90min(T4)和手术结束时(T5)记录血流动力学和EVLWI的变化;记录术毕总失血量和总输血量,单独记录CLCVP期间失血量与CVP和MAP相关性。结果与T0时比较,T1时两组CVP、T2时L组SVRI明显升高(P0.05)。与T1时比较,T4时两组HR明显增快、CI明显升高(P0.05),T2~T4时L组MAP、CVP、ITBVI和T4时C组MAP、CVP明显降低(P0.05)。与C组比较,L组T2~T4时MAP、CVP,T3、T4时SI明显降低(P0.05),而SVRI明显升高(P0.05),术中L组总失血量、总输血量和总输液量、尿量均明显减少(P0.05)。结论脊柱外科手术中应用CLCVP在减少术中失血量和输血量的同时,对患者的血流动力学和EVLW无不良影响。
[Abstract]:Objective To observe the intraoperative controlled low central venous pressure (controlled low central venous pressure, CLCVP) on the blood vessels of patients with spinal surgery lung water (extravascular lung, water, EVLW) and blood loss effects. Methods 36 patients undergoing posterior lumbar spinal canal decompression and fusion surgery were randomly divided into CLCVP group (group L) and the control group (C group), each group of 18 cases in group.L after the start of surgery by limiting the infusion with intravenous infusion of nitroglycerin to keep CVP at 2~4cm H2O, interbody fusion after the completion of the rapid expansion of the CVP normal group.C routine fluid replacement and maintenance of CVP in 6~12cm and H2O. respectively after induction of anesthesia in supine position (T0). Before hypotension prone position (T1), CLCVP 30min (T2), 60min (T3), 90min (T4) and at the end of operation (T5) to record the changes of hemodynamics and EVLWI records; postoperative total blood loss and the total volume of blood transfusion, blood loss during CLCVP are recorded separately with CVP and MAP correlation. Results compared with T0, T1 two CVP group, T2 L group SVRI increased significantly (P0.05). Compared with T1, T4 of the two groups significantly increased HR, CI increased significantly (P0.05), T2~T4 L group MAP, CVP, ITBVI and T4 in group C, MAP, CVP were significantly lower (P0.05). Compared with C group, L group, T2~T4 MAP, CVP, T3, T4, SI were significantly lower (P0.05), while SVRI increased significantly (P0.05), patients in group L the total blood loss, total blood transfusion and transfusion volume, urine volume were significantly reduced (P0.05). Conclusion spinal surgery the application of CLCVP while reduce the blood loss and blood transfusion during operation, no adverse effects on hemodynamics and EVLW patients.

【作者单位】：中南大学湘雅医院麻醉科;中南大学湘雅三医院心内科;湖南省肿瘤医院胸内一科;
【基金】：2013年贝朗麻醉科学研究基金(BBF-2013-010) 中南大学湘雅医院临床科研基金(2013L013)
【分类号】：R614

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