摘要
目的 观察围术期血液保护对颅脑肿瘤患者电解质及凝血功能的影响.方法 90例患者按照抽签法随机分为A、B、C 3组,A组术前静脉注射凝血酶2kU,在气管插管后静脉注射6%羟乙基淀粉130/0.4溶液15ml/kg,速率30ml/min,联合硝酸甘油控制性降压;B组凝血酶＋控制性降压;C组术前静脉注射凝血酶2kU.3组分别于麻醉前（基础值,T0）、手术开始后60min（T1）、术毕即刻（T2）和术后24h（T3）采血测定血红蛋白（Hb）、红细胞压积（Hct）、血小板（PLT）、电解质（K＋、Na＋、Cl-、Ca＋）、血浆凝血酶原时间（PT）、凝血酶时间（TT）、部分凝血活酶时间（APTT）和纤维蛋白原浓度（Fib）.结果 A组血液稀释后T1,时段Hb、Hct均明显低于T0（P＜0.05或0.01）.但在T2时段均恢复或接近于T0水平（P＞0.05）,而C组Hb、Hct、PLT在T2、T3时段均明显低于同组T0或A、B组同时段数值（P＜0.05或0.01）.3组血清K＋、Na＋、Cl-、Ca2＋在T1、T2时段与T0比较差异无统计学意义（P＞0.05）,但在T3时段血K＋均明显降低（P＜0.05）;A组PT、APTT和FjO在T1时段均明显延长或降低（P＜0.05）,而B组和C组在T2时段PT、APTT均延长（P＜0.05）,各组术后24h凝血功能指标均恢复T0水平.结论 凝血酶结合扩容性血液稀释与控制性降压用于颅脑肿瘤患者围术期血液保护对电解质及凝血功能无明显影响,且凝血酶可强化血小板和/或凝血因子的功能,利于术中止血.
Objective To investigate the effect of perioperative blood conservation on electrolytes and coagulation function in brain tumor patients. Methods Ninety patients were randomly divided into A, B, C three groups. Group A received thrombin 2KU i.v injection before operation, 6% hydroxyethyl starch 130/0.4 solution i.v infusion after intubation and combined with nitroglycerin to control hypotension; group B received thrombin with controlled hypotension; group C received preoperative throm- bin i.v injection only. Arterial and central venous blood samples were taken for determination of Hb, Hct, PLT, Electrolytes （K＋, Na＋ ,CI-）, PT, TT, APTT, Fib at To （baseline before anesthesia）, T, （60rain after operation）, T2 （completion of operation） and T3（24h after operation）, respectively. Results The values of Hb, Hct, PLT at T1 were lower than those at To in group A, while restored close to levels of baseline at T2. Hb, Hct, PLT at T2, T3 in group C were significantly lower than those at To or those in group A, B in the same period. There were no significant differences in values of K＋, Na＋ CL, Ca2＋ at T1 and T2 among three groups; however blood K＋ was decreased at T3. PT, APTT, Fib in group A were significantly prolonged or decreased at T1; and PT, APTT in group B and C prolonged at T2. The value of coagulation function after 24h restored close to the baseline at TO in all three groups. Conclusion Perioperative administration of thrombin combined with hypervolemic hemodilution and controlled hypotension for blood conservation have no significant effect on electrolyte and coagulation in patients with brain tumor; and thrombin may enhance blood platelets and/or coagulation factors function, which is beneficial to hemostasis.
出处
《浙江医学》
CAS
2010年第12期1767-1769,共3页
Zhejiang Medical Journal
基金
基金项目：浙江省卫生厅医药卫生科学研究基金资助项目（20098164）：衢州市科技计划项目（20091071）
关键词
凝血酶
血液稀释
控制性降压
电解质
凝血功能
thrombin hemodilution controlled hypotension electrolyte coagulation function
