急性高容量血液稀释联合控制性降压对膀胱癌患者脑氧供需平衡的影响

摘要

Objective To observe effects of acute hypervolemic hemodilution combined with controlled hypotension (AHH combined CH)on the balance of cerebral oxygen metabolism and evaluate its application value in bladder cancer surger-y.Method 35 patients with bladder cancer were selected and randomly divided into AHH combined CH group (n =18)and AHH control group (n =17).Arterial oxygen saturation (SaO2 ),arterial partial pressure of oxygen(PaO2 ),right internal jugular venous partial pressure of oxygen(PjvO2 ),carbon dioxide(PjvCO2 )and cerebral arteriovenous oxygen content difference at dif-ferent timing,such as anesthesia induction (T0 ),after AHH or AHH combined with CH (T1 )and completion of the operation, were conducted.Results Compared with T0 ,cerebral arteriovenous oxygen content difference(CjvO2 )had no significant change while CaO2 and CajvO2 decreased in two groups at T1 and T2 (P >0.05).There was no significant change for CVP and CERO2%in AHH control group,whereas CVP,CajvO2 and cerebral oxygen extraction rate (CERO2%)decreased significantly,the differ-ence was statistically significant in AHH combined CH group (P <0.05).AHH combined CH group had a significant difference among CajvO2 ,CVP and CERO2% at T1 ~T2 (P <0.05).Conclusion AHH combined with CH could safely keep the balance of oxygen in brain,which is fit for patients with bladder cancer operation.%目的：观察急性高容量血液稀释联合控制性降压对脑氧供需平衡的影响，评价其在膀胱癌根治手术中的应用价值。方法：选取行膀胱癌根治手术患者35例，随机分为 AHH 联合 CH 组（n ＝18）和 AHH 对照组（n ＝17）。记录麻醉诱导后（T0）、AHH 或 AHH 联合 CH 后30 min（T1）、术毕（T2）不同时间点的动脉血氧饱和度、动脉血氧分压、右颈内静脉球部血氧分压、二氧化碳分压、中心静脉压等指标。结果：与 T0比较，T1、T2时点 CjvO2在两组中均无明显变化，而 CaO2、CajvO2在两组中均下降，差异有统计学意义（P ＜0.05）。CVP、CERO2％在 AHH 对照组中无明显变化，在 AHH联合 CH 组中，CVP、CajvO2、CERO2％显著下降，差异均有统计学意义（P ＜0.05）。与对照组比较，T1、T2时点 AHH 联合CH 组中 CajvO2、CVP、CERO2％，差异有统计学意义（P ＜0.05）。结论：AHH 联合 CH 可维持脑氧供需平衡及稳定，安全性好，能应用于膀胱癌根治手术患者。