急性超容量血液稀释对行腰椎手术患者血流动力学的影响

王玲玲; 麻伟青; 李治贵; 李娜; 黄治国

急性超容量血液稀释对行腰椎手术患者血流动力学的影响

解放军联勤保障部队第九二0医院麻醉科

基金项目:

基金：成都军区“十二五”医学科研基金资助项目 (B14013);

计量
- 文章访问数: 1708
- HTML全文浏览量: 590
- PDF下载量: 32
- 被引次数: 0
出版历程
- 收稿日期: 2018-11-13

Effect of Acute Hypervolemic Hemodilution on Hemodynamics in Patients Undergoing Lumbar Surgery

Funds:

基金：成都军区“十二五”医学科研基金资助项目 (B14013);

摘要

摘要: 目的探讨急性超容量血液稀释对俯卧位下行腰椎手术患者血流动力学的影响。方法选择拟行腰椎手术俯卧位患者150例, 随机分为3组, 乳酸林格氏液组 (n=50) :麻醉诱导后30 min内输入乳酸林格氏液15 m L/kg;羟乙基淀粉组1 (n=50) :麻醉诱导后30 min内输入羟乙基淀粉氯化钠 (130/0.4) 15 m L/kg;羟乙基淀粉组2 (n=50) :麻醉诱导后30 min内输入羟乙基淀粉氯化钠 (130/0.4) 20 m L/kg。采用Flo Trac/Vigilo心排量监测仪, 连续监测患者每间博量指数 (SVI) 、心输出量指数 (CI) 、心脏每搏变异度 (SVV) 等各项指标;记录和分析患者仰卧位及俯卧位后平均动脉压 (MAP) 、心率 (HR) 、CI、SVI、SVV、中心静脉压 (CVP) 及气道压 (P) 。结果和仰卧位比较, RS组患者俯卧位后10 min CI、SVI、CVP均明显降低 (P<0.05) , MAP、SVV和气道压力明显增加 (P<0.05) , HR无明显变化 (P> 0.05) ;HES1组上述各参数变化趋势和RS组一致, 但俯卧位和仰卧位之间各参数差异比RS组明显减小;HES2组俯卧位后CI、SVI、HR、SVV和仰卧位之间均无明显差异 (P> 0.05) , 俯卧位后MAP和气道压力较仰卧位明显增加 (P<0.05) 。结论急性血液稀释 (HES 15 m L/kg和20m L/kg) 均可以改善俯卧位后血流动力学波动, HES 20 m L/kg更有利于维持俯卧位后循环稳定。
- 急性超容量血液稀释 /
- 腰椎手术 /
- 俯卧位 /
- 心排量
Abstract: Objective To investigate the effect of acute hypervolemic hemodilution on hemodynamics in patients undergoing lumbar surgery in prone position. Methods 150 patients in prone position were randomly divided into 3 groups: Ringer's lactate solution group (n=50) : Ringer's lactate solution 15 m L/kg was injected within 30 minutes after anesthesia induction; hydroxyethyl starch group 1 (n=50) ;hydroxyethyl starch sodium chloride (130/0.4) 15 ml/kg was injected within 30 minutes after anesthesia induction; hydroxyethyl starch group 2 (n=50) : after induction of anesthesia, hydroxyethyl starch sodium chloride (130/0.4) 20 ml/kg was injected into 30 min. Flo Trac/Vigilo cardiac output monitor was used to continuously monitor the patients' SVI, CI, SVV, MAP, HR, CI, SVI, CVP and CVP in supine and prone positions. Airway pressure (P) . Results Compared with the supine position, the CI, SVI and CVP in RS group decreased significantly 10 minutes after prone position (P < 0.05) , MAP, SVV and airway pressure increased significantly (P < 0.05) , HR did not change significantly (P > 0.05) ;the change trend of the above parameters in HES1 group was the same as that in RS group, but the difference of parameters between prone position and supine position was more obvious than that in RS group. There was no significant difference in CI, SVI, HR, SVV and supine position after prone position in HES2 group (P > 0.05) , MAP and airway pressure after prone position were significantly higher than those in supine position (P < 0.05) . Conclusion Acute hemodilution (HES 15 m L/kg and 20 m L/kg) can improve the hemodynamic fluctuation after prone position, and HES 20 ml/kg is more beneficial to maintain the circulation stability after prone position.
- Acute hypervolemic hemodilution /
- Lumbar surgery /
- Prone position /
- Cardiac output

HTML全文

参考文献(15)

[1]	[1]BIJKER J B, VAN KLEI W A, KAPPEN T H, et al.Incidence of intraoperative hypotension as a function of the chosen definition:literature definitions applied to a retrospective cohort using automated data collection[J].Anesthesiology, 2007, 107 (2) :213-220.
[2]	[2]DHARMAVARAM S, JELLISH WS, NOCKELS R P, et al.Effect of prone positioning systems off hemodynamic and cardiac function during lumbar spine surgery:an echocardiographic study[J].Spine, 2006, 31 (12) :1388-1393
[3]	[3]SNYGG J, BECH-HANSSEN O, LONN L, et a1.Fluid therapy in acute myocardial infarction:evaluation of predictors of volume responsivencss[J].Acta Anaestllesiol Scand, 2009, 53 (1) :26-33.
[4]蒋海燕, 李俊杰, 李薇, 等.目标导向液体治疗对高龄胃肠道肿瘤患者术后的影响[J].昆明医科大学学报, 2015, 36 (12) :100-103.
[5]	[5]DAIHUA Y, WEI C, XUDE S, et al. The effect of body position changes on stroke volume variation in 66mechanically ventilated patients with sepsis[J]. Journal of Critical Care, 2012, 27 (4) :7-12.
[6]	[6]WU C Y, LEE T S, CHAN K C, et al. Does targeted pre-load optimisation by stroke volume variation attenuate a reduction in cardiac output in the prone position[J].Anaesthesia, 2012, 67 (7) :760-764.
[7]	[7]HATTORI K, MAEDA T, MASUBUCHI T, et al. Accuracy and trending ability of the fourth-generation flo trac/vigileo system in patients with low cardiac index[J]. J Cardiothorac Vasc Anesth, 2017, 31 (1) :99-104.
[8]林玉霜, 唐华东, 郑志强, 等.急性高容量血液稀释复合控制性降压在脊柱外科手术中的应用[J].临床麻醉学杂志, 2009, 25 (12) :1099-1099.
[9]郑进, 王冰.应用不同液体急性等容血液稀释对脊柱手术患者血流动力学的影响[J].牡丹江医学院学报, 2017, 38 (02) :74-77.
[10]	[10]Assessment of hemodynamic efficacy and safety of 6%hydroxyethylstarch 130/0.4 vs. 0.9%Na Cl fluid replacement in patients with severe sepsis:The CRYSTMAS study[J]. Critical Care, 2012, 16 (3) :1-10.
[11]	[11]LEE T C, YANG L C, CHEN H J. Effect of patient Position and hypotensive anesthesia on inferior vena caval pressure[J]. Spine, 1998, 23 (8) :941-947.
[12]	[12]BIAIS M, BERNARD O, HA J C, st a1.Abilities of pulse pressure variations and stroke volume variations to predict fluid responsiveness in prone position during scoliosis surgery[J].Br J Anaesth, 2010, 104 (8) :407-413.
[13]	[13] DAIHUA Y, WEI C, XUDE S, et al. The effect of body position changes on stroke volume variation in 66mechanically ventilated patients with sepsis[J]. Journal of Critical Care, 2012, 27 (4) :7-12.
[14]于瀛, 倪小庸, 杜惠斌, 等.急性高容量血液稀释联合硬膜外阻滞用于患者手术的临床观察[J].临床麻醉学杂志, 2006, 22 (8) :640-641.
[15]	[15]HERING R, WRIGGE H, VORWERK R, et al. The effects of prone positioning on intraabdominal pressure and cardiovascular and renal function in patients with acute lung Injury[J]. Anesthesia and Analgesia, 2001, 92 (5) :1226-1231.

相关文章(20)

[1]	丁恒, 胡乐, 李由, 崔亮, 张帆, 李兴国. UBE术式与常规开放手术治疗腰椎间盘突出症的临床和放射学结果分析, 昆明医科大学学报. doi: 10.12259/j.issn.2095-610X.S20240910
[2]	邓婉, 周玉娥, 杨严政, 廖桂. 间歇俯卧位通气在新生儿呼吸窘迫综合征中的应用效果, 昆明医科大学学报. doi: 10.12259/j.issn.2095-610X.S20210646
[3]	邵彬, 汤志伟, 张婧, 董佩娴, 晁云萍. 改良式体位垫降低俯卧位压力性损伤发生率的应用, 昆明医科大学学报. doi: 10.12259/j.issn.2095-610X.S20210727
[4]	周玉娥, 尹丽娟, 杨慧波. 俯卧位对早产儿呼吸暂停的影响, 昆明医科大学学报.
[5]	陈太邦, 陆声, 石俊贞, 施荣茂, 梁金龙. 经皮椎弓根螺钉与传统开放式手术治疗A3型胸腰椎骨折临床疗效比较, 昆明医科大学学报.
[6]	赵辉, 纳强, 赵佳. 腰椎退行性侧弯合并多节段腰椎管狭窄的短期手术疗效分析, 昆明医科大学学报.
[7]	张英, 李洪艳, 陈思芳, 廖瑞雪. 回弹型体位垫在ERCP术中左侧俯卧位的应用, 昆明医科大学学报.
[8]	颜悦新, 徐冕, 杨德兴, 刘桠名, 周凤高, 许成, 刘荣. ARDS患者行俯卧位通气时应用死腔分数评价疗效, 昆明医科大学学报.
[9]	李全, 张源, 梁跃伟, 阮锐, 赵学凌, 谢世伟, 张霖. 腰椎手术并发症-脑脊液漏的研究进展, 昆明医科大学学报.
[10]	宋涛, 肖帆. 光棒引导下气管插管对鼾症手术患者血液动力学的影响, 昆明医科大学学报.
[11]	郑军. 后路椎间盘镜手术与开放椎板开窗手术治疗腰椎间盘突出症的疗效对比, 昆明医科大学学报.
[12]	刘荣. 慢性阻塞性肺疾病急性加重患者机械通气后期应用俯卧位通气呼吸和循环的临床评价, 昆明医科大学学报.
[13]	赖碁. 急性下壁心肌梗死合并高度AVB时临时起搏治疗手术方法探讨, 昆明医科大学学报.
[14]	张跃平. 左半结肠癌并发急性肠梗阻Ⅰ期手术治疗体会, 昆明医科大学学报.
[15]	张跃平. 左半结肠癌并发急性肠梗阻Ⅰ期手术治疗体会, 昆明医科大学学报.
[16]	袁维诚. 手术治疗胸腰椎爆裂性骨折96例临床体会, 昆明医科大学学报.
[17]	杨冬梅. 同侧俯卧位纠正产妇胎方位240例临床观察, 昆明医科大学学报.
[18]	. 两种血液稀释方法对直肠癌患者围术期T淋巴细胞亚群的影响, 昆明医科大学学报.
[19]	陈本鑫. 腹腔镜和开腹手术治疗老年急性化脓性阑尾炎临床观察, 昆明医科大学学报.
[20]	. 胸腰椎爆裂骨折28例前路手术并发症分析, 昆明医科大学学报.