小儿脊柱侧弯手术中急性高容量血液稀释的临床观察

[Clinical observation of acute hypervolemic hemodilution in scoliosis surgery on children].

作者信息

Chen Yi-qi, Chen Yu, Ji Chen-song, Gu Hong-bin, Bai Jie

机构信息

Department of Anesthesiology, Shanghai Children's Medical Center, Shanghai Jiaotong University, Shanghai 200127, China.

出版信息

Zhonghua Yi Xue Za Zhi. 2008 Nov 11;88(41):2901-3.

PMID:19080095

Abstract

OBJECTIVE

To evaluate the clinical efficacy and safety of acute hypervolemic hemodilution (AHH) in posterior spinal fusion surgery in children.

METHODS

36 children with scoliosis ASA I approximately II, receive of posterior spinal fusion, were randomly divided into 2 equal groups: AHH group, transfused with hydroxyethyl starch 130/0.4 and sodium chloride (Voluven) 12 ml/kg at the speed of 0.3 approximately 0.4 mlxkg(-1)xmin(-1) (for 30 approximately 40 min) through internal jugular vein before operation so as to keep the hemodilution (Hb) status during operation, and control (CNT) group. During operation when the Hb was <80 g/L or the hematocrit was < 25% blood transfusion was conducted to maintain the Hct > 25%.

RESULTS

There was no significant difference in intra-operative blood loss between these 2 groups. The Hb one day after operation of the AHH group was (89 +/- 12) g/L, significantly lower than that immediately after operation [(98 +/- 10) g/L, P < 0.05]. The Hb one day after operation of the CNT group was (92 +/- 22) g/L, significantly lower than that immediately after operation [(94 +/- 13) g/L, P < 0.05]. However, there were not significant differences in the Hb values between the AHH and CNT groups (all P > 0.05). Both groups received intra-operative transfusion during operation. The amount of transfused red blood cells and fresh frozen plasma of the AHH group were (18 +/- 4) ml/kg and (3.5 +/- 1.1) ml/kg respectively, both significantly lower than those of the CNT group [(28 +/- 11) and (5.8 +/- 1.8) ml/kg respectively, both P < 0.05].

CONCLUSION

Able to reduce intra-operative blood transfusion and medical expense, AHH can be used safely and effectively in posterior spine fusion in children.

摘要

目的

评估急性高容量血液稀释（AHH）在儿童后路脊柱融合手术中的临床疗效及安全性。

方法

将36例拟行后路脊柱融合手术的脊柱侧弯儿童患者（ASA分级Ⅰ～Ⅱ级）随机分为两组，每组18例：AHH组，于手术前经颈内静脉以0.3～0.4 ml·kg⁻¹·min⁻¹的速度输注130/0.4羟乙基淀粉氯化钠注射液（万汶）12 ml/kg，持续30～40 min，以维持术中血液稀释状态；对照组（CNT组）。术中当血红蛋白（Hb）<80 g/L或血细胞比容（Hct）<25%时进行输血，使Hct>25%。

结果

两组术中失血量差异无统计学意义。AHH组术后1天Hb为（89±12）g/L，明显低于术后即刻的（98±10）g/L（P<0.05）。CNT组术后1天Hb为（92±22）g/L，明显低于术后即刻的（94±13）g/L（P<0.05）。但AHH组与CNT组术后1天Hb值差异无统计学意义（均P>0.05）。两组术中均进行了输血。AHH组输注红细胞悬液和新鲜冰冻血浆量分别为（18±4）ml/kg和（3.5±1.1）ml/kg，均明显低于CNT组的（28±11）ml/kg和（5.8±1.8）ml/kg（均P<0.05）。