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[肾下腹主动脉瘤择期手术治疗中心肌缺血风险及输液输血治疗的本质]

[A risk of myocardial ischemia and the nature of infusion-transfusion therapy in scheduled surgical treatment of infrarenal aneurisms of the aorta].

作者信息

Merkulov I V, Neĭmark M I

出版信息

Anesteziol Reanimatol. 2004 Jul-Aug(4):11-4.

Abstract

The authors analyzed effects produced by different variations of the infusion-transfusion therapy on the risk of cardiovascular complications that can develop in the scheduled surgical treatment of the aorta abdominal part. The patients were randomized in 2 groups. Intraoperative hemodilution was made in group-1 patients (n = 50) before aorta clipping. Hemodynamics was stabilized by colloids and crystacolloids during clip removal; donor packed red blood cells were used at the hemoglobin level below 80 g/l. Group 2 comprised 66 patients for whom autoblood was prepared preoperatively. The infusion volume was limited before aorta clipping; blood losses were compensated for by autoblood and autoerythrocytes collected from surgical blood by "Cell Saver". The below results were obtained on the basis of conducted research: preventive infusion load aggravates, before aorta clipping, the risk of cardiac complications. Maintenance of Hb below the level of 90 g/l is accompanied by an impaired transport of oxygen to tissues; it speeds up the heart beat and provokes an increased cardiac need in oxygen, which enhances the risk of myocardium ischemia. Preparation of autoblood and hardware-based reinfusion of autoerythrocytes provide for an adequate compensation of blood losses and diminish the risk of cardiac complications in the scheduled surgical treatment of infrarenal aneurisms of the aorta.

摘要

作者分析了在腹主动脉预定手术治疗中,不同输液输血治疗方式对心血管并发症风险产生的影响。患者被随机分为两组。第一组(n = 50)患者在夹闭主动脉前进行术中血液稀释。在移除夹子期间,通过胶体液和晶体胶体液稳定血流动力学;当血红蛋白水平低于80 g/l时使用供体浓缩红细胞。第二组包括66例术前准备自体血的患者。在夹闭主动脉前限制输液量;通过自体血和用“细胞回收器”从手术失血中收集的自体红细胞来补偿失血。基于所进行的研究得出以下结果:预防性输液负荷在夹闭主动脉前会加重心脏并发症的风险。血红蛋白维持在90 g/l以下会伴随着组织氧运输受损;它会加快心跳并引发心脏对氧气需求增加,从而增加心肌缺血的风险。自体血制备和基于硬件的自体红细胞回输可充分补偿失血,并降低腹主动脉肾下动脉瘤预定手术治疗中心脏并发症的风险。

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