目的：探讨急性高容量血液稀释(AHH)联合控制性降压(CH)在俯卧位脊柱手术中临床效果及安全性。方法选择2011年1月~2013年1月在深圳市第二人民医院骨科进行脊柱手术的72例患者,分为观察组和对照组,每组各36例。两组均采用静吸复合麻醉,观察组应用AHH联合CH；对照组常规补液。比较两组术中失血量、输血量、补液量及尿量；两组诱导前(T0)、AHH后(T1)、手术结束(T2)时的心率(HR)、平均动脉压(MAP)和中心静脉压(CVP)；两组T0、T1、T2和术后1 d(T3)时两组血红蛋白(Hb)含量和血细胞比容(HCT)；两组T0、T2时凝血功能相关指标；由手术医师对两组术“进行Fromme评分,并进行比较。结果淤观察组失血量、输血量少于对照组,输液量及尿量均多于对照组,差异均有高度统计学意义(P=0.0000)。于两组各时间点HR比较,差异无统计学意义(P跃0.05),T1时观察组MAP较T0时降低[(86.9±15.8)mm Hg(1 mm Hg =0.133 kPa)比(68.9±14.1)mm Hg],差异有高度统计学意义(t =5.1000,P=0.0000),且低于对照组T1时[(68.9±14.1)mm Hg比(85.6±14.4)mm Hg],差异有高度统计学意义(t =5.2773,P=0.0000)；T1、T2时观察组CVP值较T0时升高[(10.8±1.6)、(11.1±2.3)cm H2O比(7.5±1.3)cm H2O(1 cm H2O=0.098 kPa)],差异有高度统计学意义(t=9.6044、8.1757,P=0.0000),且高于对照组同时相[(10.8±1.6)cm H2O比(6.9±1.4)cm H2O,(11.1±2.3)cm H2O比(8.6±1.7)cm H2O],差异有高度统计学意义(t=11.0064、5.2446,P=0.0000)。盂观察组T1时Hb和HCT低于对照组[(99.8±13.9)g/L比(121.6±14.5)g/L,(27.1±3.9)豫比(38.7±4.1)豫],差异有高度统计学意义(t=6.6115、12.2998,P=0.0000),观察组T2时Hb低于对照组[(88.8±13.1)g/L比(108.3±14.6)g/L],差异有高度统计学意义(t =5.9647,P=0.0000),观察组T1、T2、T3时Hb低于T0时[(99.8±13.9)、(88.8±13.1)、(98.6±14.2)g/L比(124.6±10.8)g/L],差异有高度统计学意义(t =8.4533、12.6517、8.7442,P=0.0000),T1、T2时HCT低于T0时[(27.1±3.9)豫、(26.2±4.7)豫比(38.7±3.9)豫],差异有高度统计学意义(t=12.6191、12.2802,P=0.0000)。榆两组T0、T2时PT、APTT均在正常范围内,组间比较差异无统计学意义(P跃0.05)。虞观察组术“Fromme评分低于对照组[(2.1±0.5)分比(3.3±0.6)分],差异有高度统计学意义(t =9.2187,P=0.0000)。结论俯卧位脊柱手术应用AHH和CH可减少术中失血量,使术“更清晰,对血流动力学、组织血液供应及凝血功能影响小,是术中安全有效的血液保护方法。%Objective To investigate the effectand safety of acute hypervolemic hemodilution (AHH) combined with controlled hypotension (CH) in spinal operation atprone position. Methods 72 patients with spine surgery atDepart-mentof Orthopedics in the Second People's Hospital of Shenzhen City, from January 2011 to January 2013, were as the research objects, and they were divided into observation group and control group, with 36 cases in each group. All the patients were treated with intravenous inhalation anesthesia, the patients in the observation group were treated with AHH combined with CH, while the control group was treated with conventional fluid infusion. The blood volume, blood transfusion, fluid intake and urine outputof the patients in two groups;before induction (T0), after AHH (T1), end of op-eration (T2) the heartrate (HR), mean arterial pressure (MAP) and central venous pressure (CVP) of the two groups, blood protein (Hb) contentand the hematocrit(HCT) of patients in two groups atT0, T1, T2 and 1 d after operation (T3); the related indexes of blood coagulation func-tion atT0, T2; the operation doctor underwentFromme scores of operation field on patients in two groups, and compared those between groups, above all the indexes werer observed and compared. Results [1]The blood loss, blood transfusion amountof patients in the observation group were less than those in the control group, the infusion and urine volume were more than those in the control group, the differences were statistically significant(P= 0.0000). [2]There was no statistical difference ateach time pointHR between the two groups (P>0.05); MAP of the observation group atT1 were decreased than thatatT0 [(86.9±15.8) mm Hg (1 mm Hg =0.133 kPa) vs (68.9±14.1) mm Hg], the difference was sta-tistically significant(t= 5.1000, P=0.0000), and itwas lower than thatof the control group atT1 [(68.9±14.1) mm Hg vs (85.6±14.4) mm Hg], the difference was statistically significant(t= 5.2773, P= 0.0000); CVP value of the observa-tion group atT1, T2 were higher than thatatT0 [(10.8±1.6), (11.1±2.3) cm H2O ( 1 cm H2O=0.098 kPa) vs (7.5±1.3) cm H2O], the differences were statistically significant(t=9.6044, 8.1757, P=0.0000), and they were higher than those of the control group [(10.8±1.6) cm H2O vs (6.9±1.4) cm H2O, (11.1±2.3) cm H2O vs (8.6±1.7) cm H2O], the differences were statistically significant(t=11.0064, 5.2446, P=0.0000).[3] Hb and HCT of the observation group atT1 were low-er than those of the control group [(99.8±13.9) g/L vs (121.6±14.5) g/L, (27.1±3.9)% vs (38.7±4.1)%], the differences were statistically significant(t=6.6115, 12.2998, P=0.0000);Hb of the observation group atT2 was lower than thatof the control group [(88.8±13.1) g/L vs (108.3±14.6) g/L], the difference was statistically significant(t= 5.9647, P=0.0000); Hb of the observation atT1, T2, T3 were lower than thatatT0 [(99.8±13.9), (88.8±13.1), (98.6±14.2) g/L vs (124.6±10.8)g/L], the difference was statistically significant(t= 8.4533, 12.6517, 8.7442, P= 0.0000); HCT atT1, T2 were lower than thatatTa [(27.1±3.9)%, (26.2±4.7)% vs (38.7±3.9)%], the differences were statistically significant(t=12.6191, 12.2802, P=0.0000). [4]PT, APTT of the two groups atT0, T2 were in the normal range, there was no statisti-cally significantdifference between the two groups (P>0.05).⑤Fromme scores of operation of the observation group was lower than thatof the control group [(2.1±0.5) scores vs (3.3±0.6) scores], the difference was statistically significant(t=9.2187, P= 0.0000). Conclusion AHH and CH in spinal operation atprone position can reduce the blood loss during the operation, and make the operation field more clear, ithas small influence on hemodynamics, blood supply function and coagulation, blood protection, itis safe and effective method in operation.
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