文章摘要
王宁,朱美华,刘莉,陈建平,陆军,罗巧中,阮义峰.急性高容量血液稀释联合控制性降压用于30例脑膜瘤手术的临床观察[J].南京医科大学学报,2007,(5):507~510
急性高容量血液稀释联合控制性降压用于30例脑膜瘤手术的临床观察
A study of slight acute hypervolemic hemodilution combined with controlled hypotension in meningioma surgery of 30 cases
投稿时间:2006-10-23  
DOI:10.7655
中文关键词: 脑膜瘤  血液稀释  控制性降压
英文关键词: meningioma  hypervolemic hemodilution  controlled hypotension
基金项目:
作者单位
王宁 南京医科大学附属南京脑科医院麻醉科江苏 南京 210029 
朱美华  
刘莉  
陈建平  
陆军  
罗巧中  
阮义峰  
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中文摘要:
      目的:探讨急性高容量血液稀释(AHH)联合控制性降压对脑膜瘤手术患者的临床应用价值。方法:脑膜瘤择期手术患者30例,随机分为观察组(A组)和对照组(B组)。A组麻醉诱导后输入6%羟乙基淀粉(万汶 25 ml/min,15 ml/kg),B组仅常规输入平衡液。两组患者在切皮后均采用异氟醚控制性降压并维持呼气末二氧化碳分压在4.0 kPa。从颈内静脉逆行置管至球部备采血样行血气分析,行足背动脉和股静脉穿刺置管,连续监测动脉压(MAP)和中心静脉压(CVP),蛛网膜下隙置管测颅内压(ICP)。结果:AHH前后及行控制性降压后,两组MAP、HR、颅内压(ICP)、乳酸(Lac)和pH值均无显著变化(P > 0.05),A组颈内静脉血氧饱和度(SjO2)和氧分压(PO2)较AHH前和B组明显升高(P < 0.05)。结论:AHH联合控制性降压可改善脑膜瘤患者术中脑氧供需平衡,维持脑灌注和循环稳定,可安全有效地应用于临床脑膜瘤手术。
英文摘要:
      Objective:To investigate the linical value of acute hypervolemic hemodilution(AHH) combined with controlled hypotension in meningioma surgery. Methods:Thirty meningioma patients of ASA Ⅰ-Ⅱ were randomly divided into AHH group(group A,n = 15) and control group(group B,n = 15). In group A,6%HES was infused(25 ml/min,15 ml/kg) before incision(or after intubatin).Two groups patients were controlled hypotension with isofluran inhaled after incision. A jugular bulb catheter was inserted for blood gas sampling and intravascular pressure recording. Jurgular bulb gases, center pressure(CVP), intracranial pressure(ICP), cerebral perfusion pressure(CPP), mean arterial blood pressure(MAP) and heart rate(HR) were measured before and after the hemodilution. Results:The values of MAP,HR,ICP, Lac and PH had no significant change(P > 0.05) during operation. Jugular bulb oxygen saturation(SjVO2) and oxygen pressure(PO2) of group A had siginificently increased with those before AHH(P < 0.05) and group B. Conclusion:In meningioma surgery, AHH hemodilution combined with controlled hypotension, improved balance of cerebral perfusion and hemodynamics, which is a safe and effective technique.
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