| 摘要: |
| 目的观察瑞芬太尼控制性降压联合急性等容性血液稀释（ANH）在复杂骨科手术中的效果和安全性。方法择期行骨科手术的患者60例，采用随机数字表法分为观察组和对照组，各30例。两组患者均在麻醉诱导后实施ANH，其中观察组术中泵注瑞芬太尼行控制性降压。分别于血液稀释前（T1）、血液稀释后即刻（T2）、手术结束时（T3）、术后24h（T4）采血测定血常规、凝血功能、血气分析，监测术前、手术开始后30min及90min、术毕、拔管后30min的平均动脉压（MAP）、心率（HR）、中心静脉压（CVP），记录失血量、输注异体血例数及输血量，统计两组术后麻醉恢复时间。结果与T1相比，两组其他时点Hb、Hct、PLT均明显降低；两组凝血指标及血气分析指标比较差异均无统计学意义（均P＞0.05）；术中不同时点观察组MAP、HR均低于对照组（均P＜0.05），拔管后30min两组MAP、HR相比差异无统计学意义（P＞0.05）；CVP在各时点差异无统计学意义（P＞0.05）；与对照组相比，观察组失血量及异体输血量、输血例数均明显降低（均P＜0.05）；两组苏醒时间、拔管时间均无统计学差异（均P＞0.05）。两组术后均未见不良事件发生。结论瑞芬太尼控制降压联合ANH在复杂骨科手术中能够减少失血量和输血量，且安全性高。 |
| 关键词: 瑞芬太尼 控制性降压 血液稀释 骨科手术 |
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| Application of remifentanil--induced hypotension combined with acute normovolemic hemodilution for patients undergoing complicated orthopedic operation |
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AN Xiaofeng, WANG Xianghe
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the 98 Hospital of PLA
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| Abstract: |
| Objective To evaluate the clinic efficacy and safety of remifentanil-induced hypotension combined with acute normovolemic hemodilution(ANH) for patients undergoing complicated orthopedic operation. Methods Sixty patients undergoing complicated orthopedic operation were randomly divided into study group and control group with 30 in each．ANH was completed after anesthesia induction in both groups. Patients in study group were infused with remifentanil for controlled hypotension．Blood routine, coagulation tests (prothrombin time, activated partial thromboplastin time) and arterial blood gas were performed before (T1) and after ANH(T2), at the end of the operation(T3) and 24h after operation(T4). The changes of mean arterial pressure (MAP), heart rate (HR) and central venous pressure (CVP) before operation, during operation, at the end of operation and 30 min after tube drawing were recorded．The volume of blood loss, the volume and rate of allogenic blood transfusion of both groups were also recorded. Results Hb, Hct and the number of platelets were significanT1y decreased after ANH in both groups (P＜0.05)．There was no significant differences between two groups in the values of PT and AHT (P ＞0.05).
MAP and HR in study group were significanT1y lower than those of control group during the operation (P＜0.05)．There was no significant differences between two groups in the values of MAP and HR at 30 min after operation (P ＞0.05)．There was no significant difference in the values of CVP between two groups. The volume of blood loss, the volume and rate of allogenic blood transfusion were significanT1y decreased in study group compared with that of control group (P＜0.05). There was no significant difference between two groups in operation time, recovery time and extubation time (P ＞0.05)．There was no postoperative complication in both groups. Conclusions Remifentanil-induced hypotension combined with ANH can reduce the volume and rate of allogenic blood transfusion, and the volume of blood loss with high safety． |
| Key words: Remifentanil Controlled hypotension Acute normovolemic hemodilution Orthopedic operation |
