急性高容量血液稀释联合控制性降压及自体血回输在骨科脊柱手术中的应用
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摘要
目的探讨急性高容量血液稀释联合控制性降压及自体血回输在骨科脊柱手术中的临床效果及安全性。方法骨科脊柱手术患者50例,分为两组,实验组采用急性高容量血液稀释、控制性降压及自体血回输技术,对照组不采取上述措施,比较两组血流动力学、血常规、凝血指标、术中出血量、自体血回输量与异体血输血量及局部脑组织氧饱和度(regional cerebral oxygen saturation,rSO2)变化。结果与对照组比较,实验组有创动脉血压(invasive artery blood pressure,IBP)下降,中心静脉压(central venous pressure,CVP)升高,红细胞压积(HCT)、血红蛋白(Hb)、血小板计数(PLT)均下降,术中异体血输入量减少,差异有统计学意义(P<0.05);术中平均出血量、活化部分凝血活酶时间(APTT)、凝血酶原时间(PT)、凝血酶时间(TT)、纤维蛋白原含量(FIB)及rSO2差异无统计学意义(P>0.05)。结论急性高容量血液稀释联合控制性降压及自体血回输可减少异体输血量,对血流动力学、凝血功能及脑组织氧合无不良影响,在骨科脊柱手术中应用较为安全。
Objective To observe the clinical efficacy and safety of acute hypervolemic hemodilution(AHH)in combination with controlled hypotension(CH)and autologous blood transfusion(ABT)on spinal surgery.Methods For this study,we enrolled 50 patients undergoing spinal surgery and randomly divided them into two groups.The experimental group received AHH in combination with CH and ABT,while the control group received none of the above treatments.We compared the parameters such as hemodynamics,blood routine and coagulation,the amount of intraoperative bleeding,autologous and allogeneic blood transfusion volume,and regional cerebral oxygen saturation(rSO2)between the two groups.Results In the experimental group CVP increased,while invasive artery blood pressure, HCT, Hb,PLT and the amount of allogeneic blood transfusion decreased significantly compared with those of the control group(P<0.05).As for the mean intraoperative blood loss,APTT,PT,TT,FIB and rSO2,there were no significant differences between the two groups(P >0.05).Conclusion AHH in combination with CH and ABT can reduce the amount of allogeneic blood transfusion and has no adverse effect on hemodynamics,blood coagulation or cerebral oxygenation in spinal surgery patients.It is a safe and effective blood protection procedure during spinal surgery.
Objective To observe the clinical efficacy and safety of acute hypervolemic hemodilution(AHH)in combination with controlled hypotension(CH)and autologous blood transfusion(ABT)on spinal surgery.Methods For this study,we enrolled 50 patients undergoing spinal surgery and randomly divided them into two groups.The experimental group received AHH in combination with CH and ABT,while the control group received none of the above treatments.We compared the parameters such as hemodynamics,blood routine and coagulation,the amount of intraoperative bleeding,autologous and allogeneic blood transfusion volume,and regional cerebral oxygen saturation(rSO2)between the two groups.Results In the experimental group CVP increased,while invasive artery blood pressure, HCT, Hb,PLT and the amount of allogeneic blood transfusion decreased significantly compared with those of the control group(P<0.05).As for the mean intraoperative blood loss,APTT,PT,TT,FIB and rSO2,there were no significant differences between the two groups(P >0.05).Conclusion AHH in combination with CH and ABT can reduce the amount of allogeneic blood transfusion and has no adverse effect on hemodynamics,blood coagulation or cerebral oxygenation in spinal surgery patients.It is a safe and effective blood protection procedure during spinal surgery.
引文
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[11]孟建,宋兆卿,王静.急性高容量血液稀释联合控制性降压在髋关节置换术中的应用[J].中华临床医师杂志,2016,10(3):443-445.
[12]卢明军,郭建荣,王红军.不同血液稀释方法对老年骨科手术患者血流动力学的影响[J].西南国防医药,2017,27(1):60-62.
[13]李卫,刘文值,邓义江,等.急性非等容量血液稀释在脊柱手术中的应用[J].华西医学,2014,29(11):2063-2068.
[14]SCHOLS SE,FEIJGE MA,LANCE MD,et al.Effects of plasma dilution on tissue-factor-induced thrombin generation and thromboelastography:Partly compensating role of platelets[J].Transfusion,2008,48(11):2384-2394.
[15]沈社良,谢屹红,陈秉宇.自体血液回收-回输对CPB心脏手术患者围术期凝血功能的影响[J].中华麻醉学杂志,2014,34(3):270-274.
[16]庄伟强,张小霓,林财珠.急性高容量血液稀释对血液保护作用的研究进展[J].医学综述,2011,17(21):3311-3314.
[17]顾燕华,张义伟,刘洋.不同血液保护措施对老年骨科手术患者围术期凝血及纤溶功能的影响[J].中国老年学杂志,2016,36(21):5390-5393.
[18]唐纯海,吴金理.术前急性等容血液稀释联合术中自体血回收在神经外科手术中的应用[J].天津医药,2012,40(2):178-179.
[19]吴松霏,刘洪涛.近红外光谱脑氧饱和度监测临床应用的研究进展[J].临床麻醉学杂志,2015,31(7):716-718.
[2]MUNOZ M,GARCIA-ERCE JA,VILLAR I,et al.Blood conservation strategies in major orthopaedic surgery:Efficacy,safety and European regulations[J].Vox Sang,2009,96(1):1-13.
[3]张卫.输血与围术期血液管理[J].实用医院临床杂志,2014,11(2):6-8.
[4]孙斌,钱宝华.围手术期血液保护的策略[J].中国输血杂志,2013,26(9):922-925.
[5]曹铭辉,何惠燕,纪风涛.术中自体血回输对脊柱手术炎性因子的影响[J].中华医院感染学杂志,2011,21(17):3571-3572.
[6]BARCELONA SL,THOMPSON AA,COTE CJ.Intraoperative pediatric blood transfusion therapy:A review of common issues.Part II:transfusion therapy,special considerations,and reduction of allogenic blood transfusions[J].Paediatr Anaesth,2005,15(10):814-830.
[7]苗玉良,刘艳,方伟武,等.自体血回收-回输术用于脊柱侧凸术效能的分析_基于倾向值匹配法的回顾性研究[J].中华麻醉学杂志,2014,34(6):733-735.
[8]刘长利,刘景汉.围术期血液保护临床应用新进展[J].临床输血与检验,2007,9(1):90-94.
[9]陈剑明,郭斌,王永和,等.术中自体血回输在骨科大手术中的应用[J].中国输血杂志,2009,22(5):395-396.
[10]钟锦秀,张培冰.急性高容性血液稀释联合控制性降压在人工全髋关节置换术中的应用[J].中国医药导刊,2015,17(6):602-604.
[11]孟建,宋兆卿,王静.急性高容量血液稀释联合控制性降压在髋关节置换术中的应用[J].中华临床医师杂志,2016,10(3):443-445.
[12]卢明军,郭建荣,王红军.不同血液稀释方法对老年骨科手术患者血流动力学的影响[J].西南国防医药,2017,27(1):60-62.
[13]李卫,刘文值,邓义江,等.急性非等容量血液稀释在脊柱手术中的应用[J].华西医学,2014,29(11):2063-2068.
[14]SCHOLS SE,FEIJGE MA,LANCE MD,et al.Effects of plasma dilution on tissue-factor-induced thrombin generation and thromboelastography:Partly compensating role of platelets[J].Transfusion,2008,48(11):2384-2394.
[15]沈社良,谢屹红,陈秉宇.自体血液回收-回输对CPB心脏手术患者围术期凝血功能的影响[J].中华麻醉学杂志,2014,34(3):270-274.
[16]庄伟强,张小霓,林财珠.急性高容量血液稀释对血液保护作用的研究进展[J].医学综述,2011,17(21):3311-3314.
[17]顾燕华,张义伟,刘洋.不同血液保护措施对老年骨科手术患者围术期凝血及纤溶功能的影响[J].中国老年学杂志,2016,36(21):5390-5393.
[18]唐纯海,吴金理.术前急性等容血液稀释联合术中自体血回收在神经外科手术中的应用[J].天津医药,2012,40(2):178-179.
[19]吴松霏,刘洪涛.近红外光谱脑氧饱和度监测临床应用的研究进展[J].临床麻醉学杂志,2015,31(7):716-718.