本文關(guān)鍵詞： 急性等容血液稀釋 控制性降壓 脊柱手術(shù) 異體輸血　出處：《廣西醫(yī)科大學(xué)》2014年碩士論文　論文類(lèi)型：學(xué)位論文

【摘要】：目的觀察急性等容血液稀釋(ANH)聯(lián)合控制性降壓(CH)應(yīng)用于脊柱手術(shù)的效果和安全性。 方法對(duì)我院脊柱骨病外科2013年4月至2013年9月?lián)衿谌橄滦屑怪鶑?fù)雜手術(shù)術(shù)中行ANH聯(lián)合CH患者55例(觀察組)及2012年10月至2013年3月脊柱復(fù)雜手術(shù)術(shù)中單純行CH的55患者(對(duì)照組)進(jìn)行總結(jié)比較。觀察組于麻醉誘導(dǎo)后按Gross公式行ANH至Hct為0.30,兩組均于手術(shù)開(kāi)始時(shí)泵注硝酸甘油復(fù)合艾司洛爾行控制性降壓至MAP為60～70mmHg。兩組均在麻醉誘導(dǎo)前(To)、麻醉誘導(dǎo)后CH前(T1)、CH平穩(wěn)后20min(T2)、手術(shù)結(jié)束前30min(T3)及術(shù)畢即刻(T4)記錄MAP、HR；在T0、T2、T4、術(shù)后第一天(T5)及出院前(T6)檢測(cè)Hb、Hct、PLT:在T0、T5時(shí)點(diǎn)檢測(cè)PT、APTT、FIV;在T2、T4時(shí)點(diǎn)檢測(cè)pH.PaC02.Pa02.BE. HCO3-、Sa02、Glu；記錄手術(shù)時(shí)間、術(shù)中輸液量、出血量和尿量,術(shù)中及術(shù)后異體輸血量、輸血例數(shù)、術(shù)后24h引流量及不良事件發(fā)生情況。 結(jié)果①兩組患者在T1、T2、T3時(shí)點(diǎn)的MAP均較T0明顯降低(P0.05)；兩組在T1、T2時(shí)點(diǎn)的HR均較T0顯著降低(P0.05)。術(shù)中同一時(shí)點(diǎn)兩組間MAP、HR的差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。②與對(duì)照組相比,觀察組術(shù)中輸液量及尿量顯著增加,術(shù)中異體輸血量及異體輸血例數(shù)顯著降低(P0.05)；兩組術(shù)中出血量及術(shù)后異體輸血量、輸血例數(shù)、引流量無(wú)顯著差異(P0.05)。③與T0時(shí)點(diǎn)比較,兩組患者術(shù)中、術(shù)后各時(shí)點(diǎn)Hb、Hct均明顯降低(P0.05)；除T2時(shí)點(diǎn)外,其余各時(shí)點(diǎn)兩組間Hb、Hct均無(wú)明顯差別(P0.05)。④與T0比較,T5時(shí)點(diǎn)觀察組PT明顯延長(zhǎng),FIB明顯減少,APPT無(wú)明顯改變。 結(jié)論與單獨(dú)行控制性降壓比較,中度急性等容血液稀釋聯(lián)合控制性降壓可顯著降低脊柱手術(shù)患者術(shù)中異體輸血量和異體輸血率,術(shù)中血流動(dòng)力學(xué)穩(wěn)定,未導(dǎo)致具有臨床意義的凝血功能異常,是脊柱手術(shù)較為理想的血液保護(hù)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.
【學(xué)位授予單位】：廣西醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類(lèi)號(hào)】：R614

【參考文獻(xiàn)】

相關(guān)期刊論文 前10條

1 鄭曼;張萍;張媛;李勇;徐鑫;王斌;;脊柱側(cè)彎矯形術(shù)中出血與輸血影響因素的探討[J];中國(guó)輸血雜志;2009年02期

2 舒運(yùn)兵;孫廣運(yùn);楊曉慧;周力平;姚洪林;;急性等容血液稀釋聯(lián)合控制性降壓在脊柱手術(shù)中的應(yīng)用[J];成都醫(yī)學(xué)院學(xué)報(bào);2011年01期

3 魏鋼;雷開(kāi)鍵;;46例腫瘤手術(shù)中自體輸血的臨床研究[J];重慶醫(yī)學(xué);2009年14期

4 錢(qián)大東;石先倫;古淼;華靜;;硝酸甘油在鼻內(nèi)鏡手術(shù)中控制性降壓的臨床觀察[J];重慶醫(yī)學(xué);2010年11期

5 王慧明;在控制性降壓下實(shí)施頜面和頸部大手術(shù)[J];國(guó)外醫(yī)學(xué).麻醉學(xué)與復(fù)蘇分冊(cè);1995年01期

6 孫怡;血液稀釋的分類(lèi)應(yīng)用及其對(duì)重要器官功能的影響[J];國(guó)外醫(yī)學(xué).麻醉學(xué)與復(fù)蘇分冊(cè);2002年05期

7 周康華;傅朝文;;瑞芬太尼控制性降壓聯(lián)合急性等容血液稀釋在全髖置換術(shù)中的應(yīng)用[J];重慶醫(yī)學(xué);2013年11期

8 鄭艇;張小霓;林財(cái)珠;;不同程度血液稀釋對(duì)家兔腦氧代謝的影響[J];臨床麻醉學(xué)雜志;2009年01期

9 王忠岳,李清平,李世文,朱海倫,王磊;血液稀釋對(duì)控制性降壓下腎功能的保護(hù)作用[J];浙江臨床醫(yī)學(xué);2004年11期

10 范里莉,曹穎俐,于瑩,李慧瓊;俯臥位脊柱手術(shù)對(duì)下肢外周靜脈壓的影響[J];南方護(hù)理學(xué)報(bào);2003年05期

，

本文編號(hào)：1495825