术前急性扩容血液稀释联合控制性降压用于脑膜瘤手术麻醉的临床研究

摘要

Objective To observe the effects of acute hypervolemic hemodilution combined controlled hypotension on blood conservation in meningioma operation.Methods 32 patients(American Society of Anesthesiologists, ASA)Ⅰ-Ⅱ scheduled for meningioma operation were randomly divided into the ecperimental group and the control group(n=16). After routine induction, 20 mL/kg of hydroxyethyl starch was quickly entered through vein in the experimental group. Nitroglycerin and esmolol were used to controlled hypotension, maintaining the mean arterial pressure (MAP) > 65 mmHg. HR, MAP, CVP, Hb and Hct were monitored and recorded at the time points of pre-induction (T1), 15 min after hemodilution (T2), surgery after the start of 60 min (T3) and end (T4).Results Compared with the control group, values of MAP at T2 were significantly high, and was lower than that at T3(P<0.05). In the experimental group, 9 patients receive blood transfusions, and blood loss was significantly lower than that of control group(P<0.05).In the control group, 15 patients receive blood transfusions, blood transfusion amount was significantly higher than that of experimental group (P<0.05).Conclusion Acute hypervolemic hemodilution combined with controlled hypotension could be safely used in meningioma operation with less blood loss.%目的：观察急性扩容血液稀释联合控制性降压对脑膜瘤手术的血液保护效果。方法择期32例美国麻醉医师协会（American Society of Anesthesiologists，ASA）I～I级脑膜瘤手术患者，随机分成对照组和试验组(n=16)。常规麻醉诱导后，试验组快速输入羟乙基淀粉20mL/kg。术中静脉用硝酸甘油和艾司洛尔实施控制性降压，维持平均动脉压（mean arterial pressure,MAP）>65mmHg。记录麻醉诱导前(T1)，血液扩容稀释后15min(T2)，手术开始后60 min(T3)及手术结束(T4)时2组患者心率（heart rate,HR）、MAP、中心静脉压（central venous pressure，CVP）、血红蛋白（hemoglobin，Hb）和血球压积（hematocrit，Hct）。结果试验组T2时MAP显著高于对照组，术中T3时MAP显著低于对照组（P<0.05）。试验组中有9例患者接受输血，出血量显著低于对照组（P<0.05）；对照组中有15例患者术中接受了异体输血，输血量显著高于试验组（P<0.05）。结论急性扩容血液稀释联合控制性降压可以安全应用于脑膜瘤手术的麻醉，减少失血量。