摘要
目的：观察控制性低中心静脉压对经椎间孔腰椎融合术（TLIF）中出血量的影响。方法将50例 ASAⅠ~Ⅱ级全身麻醉下行经椎间孔腰椎融合术的患者随机分为控制性低中心静脉压组（A 组）和对照组（B 组）。入室后，常规麻醉诱导及维持。A 组分为两个阶段：第一阶段（LCVP 期）为麻醉诱导后到螺丝钉固定完成时，液体输注速度严格控制在7 ml/ min左右，将 CVP 维持〈5 cm H2 O（1 cm H2 O =0.098 kPa）。第二阶段（LCVP 后）为螺丝钉固定完成后，以林格氏液和羟乙基淀粉补充液体缺失，恢复正常血流动力学。B 组采用传统液体管理，按照累积损失量和生理需要量以1：1的比例输入晶体液和胶体液，维持 CVP 〉10 cm H2 O，保证诱导时血流动力学的稳定。记录手术时间，并计算术中及术后出血量。测定术前和术后24 h 肝功能、肾功能。结果两组各时点 MAP、HR 比较差异无统计学意义（P 〉0.05）。与 B 组比较，A组 CVP 值在行控制性低中心静脉压期间均明显降低，两组比较差异有统计学意义（P 〈0.05）。两组手术时间、术中出血量、术后出血量比较，A 组均明显减少，差异有统计学意义（P 〈0.05）。两组患者术前及术后 ALT、AST、BUN 及 Cr 变化比较差异无统计学意义（P 〉0.05）。结论控制性低中心静脉压可明显减少 TLIF 术的术中及术后出血量，缩短手术时间，且对患者肝肾功能无影响。
Objective To observe the effect of controlled low central venous pressure on the amount of bleeding during trans-foraminal lumbar interbody fusion. Methods Fifty patients with ASA Ⅰ - Ⅱunderwent transforaminal lumbar interbody fusion under general anesthesia were randomly divided into controlled low central venous pressure（LCVP）group（group A）and control group（group B）. After arriving the operating room,the conventional anesthesia induction was adopted and maintained. Patients in group A were divided into two phases：the first phase（LCVP period）：from the induction of anesthesia to the screws fixed, with the liquid infusion rate strictly controlled at 7 ml/ min,and the CVP was maintained at 〈 5 cm H2 O. The second phase（af-ter LCVP）：after screws fixed,fluids loss was supplemented with Ringer′s solution and hydroxyethyl starch to restore normal he-modynamics. Patients in group B adopted the traditional fluid management,according to the cumulative loss and physical require-ments,colloid liquid and crystal liquid was infused at the ratio of 1：1. CVP was maintained at 〉 10 cm H2 O,to ensure the sta-ble hemodynamics during induction. The operation time was recorded,and the amount of intraoperative bleeding and postopera-tive bleeding was calculated. The preoperative and 24 h postoperative liver function and kidney function were recorded. Results There were no significant differences in MAP or HR at each time point between the two groups（P 〉 0. 05）. The CVP value was significantly lower during the period of controlled low central venous in group A than that in group B,the difference was significant（P 〈 0. 05）. Compared with group B,the surgical time,intraoperative blood loss,postoperative blood loss were sig-nificantly reduced in group A,the differences were significant（P 〈 0. 05）. There was no significant difference’in the changes of ALT,AST,BUN or Cr levels between the two groups（P 〉 0. 05）. Conclusion Controlled LCVP can significantly reduce the intraoperative and postoperative bleeding of TLIF,shorten the surgical time,and has no side effects on liver and renal function.
出处
《临床医学》
CAS
2014年第6期20-22,共3页
Clinical Medicine
关键词
中心静脉压
失血
手术时间
肝功能
肾功能
Central venous pressure
Blood loss
Surgical time
Liver function
Kidney function
