急性高容量血液稀释联合控制性降压对脊柱手术患者失血量、内稳态及微球蛋白、胱抑素-C水平的影响
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摘要
目的:探讨急性高容量血液稀释(AHH)联合控制性降压(CH)对脊柱手术患者失血量、内稳态及β_2-微球蛋白(β_2-MG)、胱抑素-C(Cys-C)水平的影响。方法:选取脊柱手术患者72例,随机分为观察组(36例)与对照组(36例)。观察组麻醉后输注6%羟乙基淀粉(130/0.4)20ml/kg,手术开始后输注硝酸甘油0.2～1.0μg/(kg·min)行CH,使MAP下降并维持在55～65mmHg(1mmHg=0.133kPa)。对照组仅采用CH。于AHH前(T0)、AHH后CH前(T1,对照组为置管后CH前)、CH后30min(T2)和停止CH后30min(T3)测定2组动脉血pH值、剩余碱、K~+、Na~+、Ca~(2+)、Cl~-浓度及β_2-MG、Cys-C水平,比较2组术中出血量和输血量。结果:观察组T1、T2、T3时的pH值较T0时及对照组降低(P<0.05),剩余碱、K~+、Na~+、Ca~(2+)、Cl~-无明显变化;观察组T1时β_2-MG、Cys-C水平较T0时下降(P<0.05),T1、T2、T3时低于对照组(P<0.05)。对照组T2、T3时β_2-MG、Cys-C水平较Tl时升高(P<0.05)。观察组术中失血量、输血量明显少于对照组(P<0.05),尿量多于对照组(P<0.05)。结论:与单纯CH比较,AHH联合CH可明显减少术中出血,对患者的内环境和肾功能的影响较小。
Objective:To observe the influences of acute hypervolemic hemodilution(AHH)by hydroxyethyl starch solution combined with controlled hypotension(CH)by nitroglycerin on blood loss,homeostasis andβ_2-MG,Cys-C in spinal surgery patients.Method:Cases of 72 spinal surgery patients were divided randomly into observation group(n=36)and control group(n=36).The patients in observation group were infused 6% hydroxyethyl starch solution(130/0.4)20 ml/kg after anesthesia,at the same time nitroglycerin was infused at a rate of 0.2 to1.0μg/(kg·min)and MAP was maintained at 55 to 65 mmHg.CH was implemented in control group according to observation group.Arterial blood pH,residual base and K~+,Na~+,Ca~(2 +),Cl,β_2-MG,Cys-C at T0(prior to AHH),T1(after AHH for observation group,after cathetering for control group),T2(30 min after CH)and T3(30 min after stopping CH)were determinated in two groups.Intraoperative blood loss and blood transfusion were compared between two groups.Result:Compared with T0 and control group,pH value decreased significantly(P<0.05)and residual base,K~+,Na~+,Ca~(2+)and Clhad no obvious changes at T1,T2 and T3 in observation group.Compared with that at T0,the levels ofβ_2-MG and Cys-C at T1 decreased significantly(P<0.05)in observation group,and the levels ofβ_2-MG and Cys-C at T1,T2 and T3 were lower significantly than those in control group(P<0.05).Compared with that at T1,the levels ofβ_2-MG and Cys-C at T2 and T3 increased significantly in control group(P<0.05).Intraoperative blood loss and blood transfusion in observation group were less significantly than those in control group(P<0.05),and the urine volume was more significantly than that in control group(P<0.05).Conclusion:Compared with CH,AHH combined with CH can reduce significantly intraoperative blood loss,and have less influence on the patient's internal environment and renal function.
Objective:To observe the influences of acute hypervolemic hemodilution(AHH)by hydroxyethyl starch solution combined with controlled hypotension(CH)by nitroglycerin on blood loss,homeostasis andβ_2-MG,Cys-C in spinal surgery patients.Method:Cases of 72 spinal surgery patients were divided randomly into observation group(n=36)and control group(n=36).The patients in observation group were infused 6% hydroxyethyl starch solution(130/0.4)20 ml/kg after anesthesia,at the same time nitroglycerin was infused at a rate of 0.2 to1.0μg/(kg·min)and MAP was maintained at 55 to 65 mmHg.CH was implemented in control group according to observation group.Arterial blood pH,residual base and K~+,Na~+,Ca~(2 +),Cl,β_2-MG,Cys-C at T0(prior to AHH),T1(after AHH for observation group,after cathetering for control group),T2(30 min after CH)and T3(30 min after stopping CH)were determinated in two groups.Intraoperative blood loss and blood transfusion were compared between two groups.Result:Compared with T0 and control group,pH value decreased significantly(P<0.05)and residual base,K~+,Na~+,Ca~(2+)and Clhad no obvious changes at T1,T2 and T3 in observation group.Compared with that at T0,the levels ofβ_2-MG and Cys-C at T1 decreased significantly(P<0.05)in observation group,and the levels ofβ_2-MG and Cys-C at T1,T2 and T3 were lower significantly than those in control group(P<0.05).Compared with that at T1,the levels ofβ_2-MG and Cys-C at T2 and T3 increased significantly in control group(P<0.05).Intraoperative blood loss and blood transfusion in observation group were less significantly than those in control group(P<0.05),and the urine volume was more significantly than that in control group(P<0.05).Conclusion:Compared with CH,AHH combined with CH can reduce significantly intraoperative blood loss,and have less influence on the patient's internal environment and renal function.
引文
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[7]张亮,卿恩明,马骏.6%羟乙基淀粉等容血液稀释对非体外循环冠状动脉旁路移植术患者内环境与氧代谢的影响[J].心肺血管病杂志,2016,35(1):45-48.
[8]梁华,丁志刚,刘晓华,等.急性高容量血液稀释联合控制性降压对老年脊柱手术患者内稳态及术后认知功能的影响[J].宁夏医科大学学报,2015,37(4):400-404.
[9]王霞,王金泉.胱抑素C在慢性肾脏病肾功能评估和预后预测中的价值[J].解放军医杂志,2016,41(10):874-878.
[2]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/CD].中华临床医师杂志:电子版,2016,10(3):443-445.
[3]边冬梅,王晓娟,倪秀梅,等.急性高容量血液稀释联合右美托咪啶、硝酸甘油控制性降压在脊柱侧弯矫正术中的应用[J].实用临床医药杂志,2013,17(5):36-39.
[4]熊华平,吴志云,查本俊.急性高容量血液稀释联合控制性降压用于全髋关节置换术患者的临床观察[J].临床军医杂志,2015,43(11):843-847.
[5]张艳杰,解永强,赵顺来,等.急性高容量血液稀释联合控制性降压对全髋关节置换患者异体输血和脑氧代谢的影响[J].临床血液学杂志,2017,30(12):944
[6]程建红,白凤姬,王卫娟,等.羟乙基淀粉急性等容血液稀释对剖腹产患者血流动力学及异体输血的影响[J].临床血液学杂志,2018,31(2):127-130.
[7]张亮,卿恩明,马骏.6%羟乙基淀粉等容血液稀释对非体外循环冠状动脉旁路移植术患者内环境与氧代谢的影响[J].心肺血管病杂志,2016,35(1):45-48.
[8]梁华,丁志刚,刘晓华,等.急性高容量血液稀释联合控制性降压对老年脊柱手术患者内稳态及术后认知功能的影响[J].宁夏医科大学学报,2015,37(4):400-404.
[9]王霞,王金泉.胱抑素C在慢性肾脏病肾功能评估和预后预测中的价值[J].解放军医杂志,2016,41(10):874-878.