联合血液稀释和低血压并通过颈静脉球血氧饱和度、脑电图和心电图进行监测，可减少大型骨科手术的输血量及重症监护病房住院时间。

Combined hemodilution and hypotension monitored with jugular bulb oxygen saturation, EEG, and ECG decreases transfusion volume and length of ICU stay for major orthopedic surgery.

作者信息

Shapira Y, Gurman G, Artru A A, Ousyscher I E, Lam A M, Kollender Y, Meller I

机构信息

Division of Anesthesiology, Ben-Gurion University of the Negev, Soroka Medical Center, Beer-Sheva, Israel.

出版信息

J Clin Anesth. 1997 Dec;9(8):643-9. doi: 10.1016/s0952-8180(97)00193-1.

DOI:10.1016/s0952-8180(97)00193-1

PMID:9438892

Abstract

STUDY OBJECTIVE

To assess the efficacy and safety of hemodilution combined with induced hypotension during surgery.

DESIGN

Randomized, nonblinded, controlled study.

SETTING

Operating room suite and intensive care unit (ICU) at a university hospital.

PATIENTS

16 ASA physical status I and II patients who underwent general or general plus epidural anesthesia for major orthopedic surgery.

INTERVENTIONS

In Group 1 (n = 10), mean arterial blood pressure (MAP) was decreased to 50 mmHg by increasing the inspired concentration of isoflurane and injecting 75 mg of 0.5% bupivacaine into the epidural catheter. Hematocrit was decreased to 20% by phlebotomy and simultaneous infusion of crystalloid and colloid. In Group 2 (n = 6), isoflurane was adjusted to maintain MAP within 20% of baseline values, and no phlebotomy or hemodilution was used.

MEASUREMENTS AND MAIN RESULTS

Efficacy of hemodilution combined with induced hypotension (Group 1) was compared to standard management of blood volume and pressure (Group 2) by measuring transfusion volume and length of ICU stay. Safety of hemodilution/hypotension was determined by measuring the electroencephalogram, internal jugular venous oxygen saturation, the electrocardiogram, and central venous oxygen saturation. In Group 1, both the volume of homologous blood (225 +/- 150 ml) and total blood (1440 +/- 286 ml) was significantly less than the volume of homologous blood transfused in Group 2 (2650 +/- 878 ml). No patients in Group 1, but all patients in Group 2 required ICU admission (3.5 +/- 1.6 days) for treatment to prevent sequelae from, or progression of, moderate-severe tissue edema and metabolic acidosis. Cerebral and myocardial measures were not significantly different between groups.

CONCLUSIONS

Hemodilution combined with induced hypotension was safe and may reduce the need for transfusion and ICU admission.

摘要

研究目的

评估手术期间血液稀释联合控制性低血压的疗效和安全性。

设计

随机、非盲、对照研究。

地点

大学医院的手术室套房和重症监护病房（ICU）。

患者

16例美国麻醉医师协会（ASA）身体状况为I级和II级的患者，接受全身麻醉或全身麻醉联合硬膜外麻醉进行大型骨科手术。

干预措施

第1组（n = 10），通过增加异氟烷吸入浓度并向硬膜外导管注入75 mg 0.5%布比卡因，将平均动脉压（MAP）降至50 mmHg。通过放血并同时输注晶体液和胶体液，使血细胞比容降至20%。第2组（n = 6），调整异氟烷以维持MAP在基线值的20%以内，未进行放血或血液稀释。

测量指标及主要结果

通过测量输血量和ICU住院时间，比较血液稀释联合控制性低血压（第1组）与血容量和血压的标准管理（第2组）的疗效。通过测量脑电图、颈内静脉血氧饱和度、心电图和中心静脉血氧饱和度，确定血液稀释/低血压的安全性。第1组的同源血量（225±150 ml）和总血量（1440±286 ml）均显著少于第2组输注的同源血量（2650±878 ml）。第1组无患者需要入住ICU，但第2组所有患者均需入住ICU（3.5±1.6天）进行治疗，以预防中重度组织水肿和代谢性酸中毒的后遗症或病情进展。两组间脑和心肌指标无显著差异。