摘要
【目的】观察急性高容性血液稀释联合控制性降压对腰椎手术病人胃黏膜pH的影响。【方法】20例腰椎骨折椎板减压切开复位内固定的病人，随机分为两组，每组均为10例：一组单纯控制性降压（对照组），另一组急性高容血液稀释联合控制性降压（联合组）。对照组在手术开始时用硝酸甘油进行控制性降压，维持平均动脉压（MAP）55-60mmHg，80min后停止降压。联合组在麻醉诱导后以50ml／h的速率输入6％HES（贺斯）15ml／kg，手术开始前完成血液稀释，术中降压同对照组。联合组于诱导后动脉王管完成时（AHH前，T0，基础值）、手术开始即刻（AHH后，降压前，T1）、降压后80min（T2）、停降压后60min（T3），对照组于相应时间点，测定动脉血pH（pHa）、动脉血CO2（PaCO2）、动脉乳酸（Lac）、PiCO2与PaCO2之差[P（i-a）CO2]、胃黏膜pH（pHi）。两组病人术后均进行随访。【结果】本研究中pHa、Lac在两组间及各组内的差异无显著性。与T0点相比，对照组在T2点胃pHi明显下降（P〈0．05），P（i-a）CO2明显升高（P〈0．05）；在T3点均回复到基础水平。胃pHi及P（i-a）CO2在联合组不同时点的变化差异无显著性。T2点时胃pHi、P（i-a）CO2在两组间差异有显著性（P〈0．05）。术后随访两组病人均无并发症发生。【结论】急性高容性血液稀释联合硝酸甘油控制性降压，维持MAP在55-60mmHg水平80min，没有影响胃黏膜的酸碱平衡，可认为能维持胃黏膜的灌注及氧合。
[Objective]To evaluate the effect of acute hypervolemic hemodilution（AHH） combined with controlled hypotension （CH） on gastric intramucosal pH （pHi） in patients undergoing spinal surgery. [Methods]Twenty patients scheduled for decompression of spinal cord by laminectomy and internal fixation for fracture of lumbar spine were randomly divided into two groups （each group n = 10） ：group 1 received CH alone, group 2 received AHH＋CH. Controlled hypotension was induced with nitroglycerin to maintain mean arterial pressure （MAP）at 55-60 mmHg for 80 minutes. AHH was produced by preoperative infusion of 6 HES （15ml/Kg） after induction, 6 % HES was infused at a rate of 50ml/min. Measurements included arterial pH（pHa）, arterial CO2 （PaCO2） ,arterial lactate , the difference between PiCO2 and PaCO2 I-P（i-a） CO2, gastric intramucosal pH （pHi）. These indices were measured after induction（T0） , the beginning of operation （T1）, 80 minutes after starting hypotension（T2）, 60 minutes after recovery from hypotension（T3）. [Results] There were no differences in arterial pH and lactate either within the two groups or between the groups. Tonometric measurements showed a significant decrease from baseline in phi at T2 in group 1 （ P 〈0.05）. P（i-a） CO2 was significantly higher, compared with baseline at T2 in group 1（ P 〈0.05）. At T3 pHi and P（i-a） CO2 returned to baseline values in group 1. No differences in phi and P（i-a） CO2 were observed in group 2. A significant difference between both groups was seen in pHi and P（i-a） CO2 at T2（ P 〈0.05）. No complications resulted from AHH or CH were found in any of the groups. [Conclusion]AHH combined with CH does not impair the gastric intramucosal perfusion and oxygenation.
出处
《医学临床研究》
CAS
2006年第5期671-673,676,共4页
Journal of Clinical Research
