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[1]金新蒙,张传青,任 芹,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血管外肺水的影响[J].宁夏医科大学学报,2021,(02):129-132.[doi:10.16050/j.cnki.issn1674-6309.2021.02.005]
 JIN Xinmeng,ZHANG Chuanqing,REN Qin,et al.Effect of Acute Hypervolemic Hemodilution Combined with Controlled Hypotension on Extravascular Lung Water in Elderly Spinal Surgery Patients[J].Ningxia Medical University,2021,(02):129-132.[doi:10.16050/j.cnki.issn1674-6309.2021.02.005]
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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血管外肺水的影响(PDF)
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《宁夏医科大学学报》[ISSN:1005-8486/CN:64-1029/R]

卷:
期数:
2021年02期
页码:
129-132
栏目:
临床医学
出版日期:
2021-02-28

文章信息/Info

Title:
Effect of Acute Hypervolemic Hemodilution Combined with Controlled Hypotension on Extravascular Lung Water in Elderly Spinal Surgery Patients
文章编号:
1674-6309(2021)02-0129-04
作者:
金新蒙1 张传青2 任 芹2 杨铁毅1 卢明军2
(1. 第二军医大学附属公利医院骨科,上海 200135; 2. 第二军医大学附属公利医院麻醉科,上海 200135)
Author(s):
JIN Xinmeng1 ZHANG Chuanqing2 REN Qin2 YANG Tieyi1 LU Mingjun2
(1. Department of Orthopedics, Gongli Hospital of the Second Military Medical University,Shanghai 200135, China; 2. Department of Anesthesiology, Gongli Hospital of the Second Military Medical University, Shanghai 200135, China)
关键词:
急性高容量血液稀释控制性降压血管外肺水胸腔内血容积老年
Keywords:
acute hypervolemic hemodilutioncontrolled hypotensionextravascular lung waterintrathoracic blood volumeelderly
分类号:
R687.3
DOI:
10.16050/j.cnki.issn1674-6309.2021.02.005
文献标志码:
A
摘要:
目的 探讨急性高容量血液稀释(AHH)联合控制性降压(CH)对老年脊柱手术患者血管外肺水的影响。方法 选择行脊柱手术老年患者60例,分为对照组、AHH组、AHH联合CH组,每组各20例。分别于诱导前(T1)、诱导后5 min(T2)、手术关键步骤结束(T3)、手术结束(T4)、拔管后(T5)5个时间点,记录患者的心率(HR)、平均动脉压(MAP)、中心静脉压(CVP)、心排血指数(CI)、胸内血容量(ITBV)、血管外肺水(EVLW)的变化,以及手术时间、出血量、尿量和异体输血情况。结果 AHH联合CH组术中出血量少于对照组和AHH组(P均<0.05),且无1例输注异体血;AHH组术中异体输血率和输血量减少(P均<0.05) 。与T1时比较,T2~T4时AHH联合CH组MAP降低,AHH组CVP升高(P均<0.05),对照组T3和T4 时CI降低 (P均<0.05)。与T1和对照组比较,AHH组T2~T5时ITBV和EVLW均升高(P均<0.05),AHH联合CH组T2~T5时ITBV和EVLW差异均无统计学意义(P均>0.05)。结论 AHH联合CH应用于老年患者能起到更好的血液保护作用,且对血管外肺水无不良影响。
Abstract:
Objective To investigate the effect of acute hypervolemic hemodilution(AHH)combined with controlled hypotension(CH)on extravascular lung water in elderly patients undergoing spinal surgery.Methods Sixty patients with selective spinal surgery were enrolled in our hospital.They were randomly and equally divided into control group,AHH group and AHH combined with CH group.The HR,MAP,CVP,cardiac index(CI),intrathoracic blood volume(ITBV)and extravascular lung water(EVLW)were recorded at 5 time points:before anesthesia induction(T1),5 minutes after anesthesia induction(T2),immediately after operative critical steps(T3),immediately after surgery(T4),and after extubation(T5). Meanwhile the operation time,blood loss,urine volume and allogeneic blood transfusion were documented. Results The blood loss in AHH combined with CH group was significantly lower than that in control group and AHH group(P all<0.05),and there was no case of allogeneic blood transfusion.The rate and volume of allogeneic blood transfusion were significantly decreased in AHH group(P all<0.05). Compared with T1,MAP was significantly reduced in AHH combined with CH group from T2 to T4(P all<0.05),CVP was notably increased in AHH group from T2 to T4(P all<0.05),and CI was significantly declined in control group at T3 and T4(P all<0.05). Compared with T1 and control group,ITBV and EVLW were notably increased in AHH group from T2 to T5(P all<0.05),while ITBV and EVLW in AHH combined with CH group were not significantly different(P all>0.05). Conclusion Acute hypervolemic hemodilution combined with controlled hypotension can provide better blood protection for elderly patients and has no adverse effects on extravascular lung water.

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备注/Memo

备注/Memo:
收稿日期:2020-01-16
基金项目:上海市浦东新区重点学科群(PWZxp2017-10)
作者简介:金新蒙(1991—),硕士,住院医师,研究方向:脊柱外科。
通信作者:卢明军,男,硕士,研究方向:血液保护。E-mail: lmj0954@163.com
更新日期/Last Update: 1900-01-01