急性等容血液稀释联合控制性降压及氨基己酸在脊柱侧弯矫正术中的应用-东南大学学报医学版

急性等容血液稀释联合控制性降压及氨基己酸在脊柱侧弯矫正术中的应用

单位：1.南京大学医学院附属鼓楼医院,麻醉科,江苏,南京,210008； 2.南京大学医学院附属鼓楼医院,脊柱外科,江苏,南京,210008

分类号：R682.3

出版年·卷·期（页码）：2007·26·第五期（362-365）

摘要：

目的:探讨急性等容血液稀释联合控制性降压及氨基己酸的使用在脊柱侧弯矫正术中的应用价值.方法: 30 例全麻行脊柱侧弯后路矫正术患者,随机分为3组.A 组为对照组,术中常规输液、库存血;B 组于全麻诱导后行急性等容血液稀释,术中控制性降压,优先使用自体血;C 组于全麻诱导后行急性等容血液稀释,术中控制性降压结合使用氨基己酸,优先使用自体血.比较3组患者在术中各时点的出血量、术毕液体出入量、凝血指标和术后引流量的差异.结果: 3组患者术毕出血量B组少于A组,C组少于B组和A组,组间比较有显著差异(P＜0.05);3组皆不同程度输入库存血,但输入的库存血量相差大,组间比较有显著差异(P＜0.05);C 组术毕纤维蛋白原明显高于A、B两组,术后引流量明显少于A、B两组(P＜0.05).结论:在脊柱侧弯后路矫正术中,应用急性等容血液稀释联合控制性降压并复合使用氨基己酸,可有效减少术中出血及输入库存血,降低住院费用,减少异体输血并发症.

Objective To investigate the value about the application of acute normovolemic hemodilution in combination with controlled-hypotension and amidocaproic acid in scoliolosis-epithesis.Methods Divided the 30 patients who accepted the scoliolosis-epithesis under general anaesthesia into 3 groups by random.Group A was the controlled group which given allogenic blood;group B accepted acute normovolemic hemodilution in combination with controlled-hypotension;group C accepted acute normovolemic hemodilution in combination with controlled-hypotension and amidocaproic acid.Group B and group C were given autologous blood preferentially.Compared the difference of hemorrhage amount in every hours,the mark about blood coagulation,the drainage amount on postoperation.Results There were significant differences in the ending hemorrhage amount of group A,B and C(P<0.05);the three groups were all transfused allogenic-blood,but the mounts were different(P<0.05).The value of Fib in group C increased obviously(P<0.05),and the grainage-amount significantly decreased(P<0.05) comparing with group A and group B.Conclusion The method of acute normovolemic hemodilution in combination with controlled-hypotension and amidocaproic acid in scoliolosis-epithesis can significantly decrease the hemorrhage amount,the amount of allogenic-blood transfusion,the cost of hospitalization and the complication of allogenic-blood transfusion.

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