急性等容量血液稀释结合控制性降压用于全髋置换术的临床研究.docVIP

急性等容量血液稀释结合控制性降压用于全髋置换术的临床研究 文章来源： 　　　　 2006-7-26 9:01:32 急性等容量血液稀释结合控制性降压用于全髋置换术的临床研究 中华麻醉学杂志 1999年第7期第19卷 临床研究 作者：薛张纲　缪长虹　朱小平　仓静　蒋豪 单位：200032　上海医科大学附属中山医院麻醉科 　　关键词： 血液稀释；降压，控制性；麻醉，硬膜外；麻醉，全身；全髋置换术 　　【摘要】　目的　了解控制性降压结合急性等容量血液稀释在全髋置换术中对出血量和术后血红蛋白的影响。方法　择期全髋置换术病人20例，随机分成对照组(组Ⅰ，n＝10)和降压组(组Ⅱ，n＝10)。组Ⅰ采用硬膜外阻滞，组Ⅱ在硬膜外阻滞加全麻下手术，术前进行等容量血液稀释，术中施行控制性降压。比较两组病人的出血量、输血量和术后血红蛋白。结果　组Ⅱ病人术中平均出血(490±88)ml，比组Ⅰ病人(945±159)ml减少48.1%；组Ⅰ病人术中平均输血(620±148)ml，而组Ⅱ病人则完全避免输异体血。两组病人术后均有轻度贫血，但仍在安全水平以上，且组间差异无显著性意义(P＞0.05)。结论　急性等容量血液稀释结合控制性降压用于全髋置换术可明显减少术中出血量，对有指征的病人使用可避免输异体血。 Effects of deliberated hypotension combined with acute isovolemic hemodilution on patients undergoing total hip replacement XU Zhanggang，MIAO Changhong，ZHU Xiaoping， et al． 　　Department of Anesthesia and ICU，Zhongshan Hospital，Shangai Medical University，Shanghai 200032 　　【Abstract】 Objective To study effects of deliberated hypotension combined with acute isovolemic hemodiluion on blood loss，postoperative hemoglubin of the patients undergoing total hip replacement（THR）．Methods Twenty ASA grade Ⅰ to Ⅱ adult patients undergoing elective THR were randomized to two groups：control group（n＝10）and hypotensive group（n＝10）．In the control group，patients only received epidural block with 0．5％ bupivacaine．In the hypotensive group，all patients were anesthetized with epidural block combined with general anesthesia．Acute isovolemic hemodilution with hematocrit of 30％ was accomplished by exchanging whole blood with lactated Ringer’s solution and Hemaccel．Deliberated hypotension was induced and maintained with labetalol 0．1 mg／kg and nitroglycerin 0．1-0．2 mg intermittent injection．Intraoperative blood loss，volume of blood to be transfused during operation and postoperative hemoglobin were recorded and compared between both groups．Results Blood loss was about 48．1％ lower in the hypotensive group than that in the control group at the end of operation．The average volume of blood to be transfused during operation was 620±148 ml in the control g