急性高容血液稀释联合控制性降压对老年肿瘤患者术中血流动力学和肾功能的影响

急性高容血液稀释联合控制性降压对老年肿瘤患者术中血流动力学和肾功能的

影响

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【摘要】目的：观察术中急性高容血液稀释(acute hypervolaemic hemodilution，AHH)联合控制性降压(controlled hypotension，CH)对老年肿瘤患者血液动力学和肾功能的影响。方法：将择期行肿瘤根治术的老年患者40例随机分为AHHCH组(Ⅰ组)，CH组(Ⅱ组)，每组20例。分别观察记录麻醉平稳动静脉导管置管完成后(基础值，T0)、手术开始即刻(T1)、停止降压30 min (T2)、术毕即刻(T3)两组各个时点的平均动脉压(MAP)、心率(HR)和中心静脉压(CVP)，检测T0和T1、T3三个时点血红蛋白(Hb)浓度和红细胞比容(Hct)，各个时点血清α1微球蛋白(α1MG)浓度并检测两组T0、T3时点的血浆尿素氮(BUN)和肌酐(Cr)值，记录降压期间尿量、Fromme 术野质量评分、手术出血总量和输血量。结果：两组T1时点MAP、HR值均低于T0、T2、T3时点(P0.05)，两组T2、T3时点的CVP

值高于T0时点(P0.05)。两组T1、T3时点Hb和Hct低于T0(P0.05);在T1时点，Ⅰ组的Hb和Hct低于Ⅱ组(P0.05)。两组T3时点血清α1MG 值均高于T0时点(P0.05)，Ⅰ组降压期间尿量多于Ⅱ组(P0.05)，输血病例数Ⅰ组少于Ⅱ组(P0.05)。结论：老年肿瘤患者大手术中应用AHH 联合CH技术与单纯CH，均能维持血流动力学稳定，对肾功能无明显影响。AHH联合CH能明显减少术中出血量，减少异体血输注。在当今血源紧缺的情况下，推广应用本技术具有临床实用意义和重要社会价值。

【关键词】血液稀释;低血压;控制性;老年患者;肿瘤根治术;血流动力学;肾功能

[Abstract] Objective: To investigate the effects of acute hypervolaemic hemodilution (AHH) combined with controlled hypotension(CH) on haemodynamics and renal function in elderly patients undergoing the radical operation of carcinoma. Methods: Forty patients undergoing the scheduled radical operation of carcinoma were randomly divided into two groups : groupⅠreceived AHH combined with CH; groupⅡreceived CH alone. Mean arterial pressure (MAP), heart rate(HR) and central venous pressure(CVP) were continuously monitored and recorded before AHH(T0),AHH finished(T1),stop CH (T2), the end of operation (T3) and Hb concentration and Hct were determined at T0 and T1.Serum α1MG was determined at every point and concentrations of BUN

and CR were determined at T0 and T3. During CH,urine volume was measured and Fromme score of surgery field was assessed.Intraoperative blood loss and transfusion were measured . Results: In two groups:MAP,HR at T1 was lower than that at T0,T2,T3, and CVP at T2, T3was higher than that at T0(P0.05).Hb and Hct at T1 ingroupⅠwere lower than that in group Ⅱ.Hb and Hct at T1,T3 were lower than that at T0 in the two groups(P0.05).In two groups serum α1MG at T3 was higher than that at T0(P0.05). The urine volume during CH in groupⅠwas higher than that in groupⅡ(P0.05). The blood transfusion in groupⅠwas lower than that in groupⅡ(P0.05). Conclusion: Application of AHH combined with CH technology and simple CH in older tumor bigger operation can maintain the stability of haemodynamics, and did not affect renal function. It was safe and reliable. Both combined application can reduce intraoperatie bleeding and blood transfusion. In today′s allogeneic blood shortages, the technical application has an important practical significance and clinical social value.

[Key words] acute hypervolaemic hemodilution;controlled hypotension;elderly patients; radical operation of carcinoma;haemodynamics;renal function.

肿瘤根治性手术因手术范围广、创伤大，出血量和体液丢失量均较大。由于心血管系统衰老退变，循环储备功能下降，对术前禁食