瑞芬复合七氟烷控制性降压联合急性高容量血液稀释在髋部手术中的应用

目的探讨瑞芬太尼复合七氟烷控制性降压（CH）联合6％羟乙基淀粉急性高容量血液稀释（AHH）在髋部手术中的血液保护作用和安全性。方法选择ASAⅠ、Ⅱ级的髋部手术患者40例，除外贫血、心肝肾功能不全、严重高血压、凝血功能障碍以及肥胖患者。随机分为观察组和C对照组，每组20例，全麻诱导后即行AHH，30min内输入6％羟乙基淀粉130／0．4约15mL／kg。手术开始进人骨质操作后行CH，观察组通过泵注瑞芬太尼及吸人七氟烷，对照组通过泵注硝酸甘油维持MAP于65～70mmHg直至手术骨质操作完成。分别测定并记录AHH前、AHH后、CH前、停CH即刻、手术结束时的MAP、中心静脉压（cvP）、凝血酶原时间（PT）、活化部分凝血酶原时间（ARTT）、Hb、HCT、血小板计数（PLT）等。记录术中平均出血量、平均输血量、输血例数、尿量、清醒拔管时间及术后24h引流量。结果两组患者AⅢ后、CH前、停止CH即刻及手术结束时的ARTT和PT与AHH前比较无差异（P〉0．05）；CH期间观察组的心率（HR）显著低于降压前（P〈0．05），而对照组高于降压前（P〈0．05），对照组CVP显著低于降压前（P〈0．05），观察组与降压前相比无差异（P〉0．05）；观察组失血量明显少于对照组（P〈0．05），两组患者术后24h引流量、清醒拔管时间等比较无差异（P〉0．05）。结论瑞芬太尼复合七氟烷控制性降压联合6％羟乙基淀粉急性高容量血液稀释用于髋部手术中安全有效，且与传统药物硝酸甘油相比，瑞芬太尼复合七氟烷控制性降压具有减慢心率、降压平稳、对中心静脉压影响小、失血量少等优点。

Applicacation of acute hypervolemic hemodilution combined with controlled hypotension of remifentanil and sevoflurane in patients undergoing hip surgery

Objective To investigate the efficacy and safety of acute hypervolemic hemodi- lution combined with controlled hypotension of remifentanil and sevoflurane in patients undergoing hip surgery. Methods 40 ASA Ⅰ -- Ⅱ hip surgery patients were enrolled in this study and randomly divided into 2 groups, and each group had 20 patients： Group A was AHH combined with CH of remifentanil and sevoflurane group, Group C was the control group. During operation, the patients in the 2 groups were all routinely anesthetized with a velocity 15 mL/kg, 50 mL/min to give an acute hypervolemic hemodilution in each group; in addition, the patients in group A were given remifentanil and sevoflurane CH, and the patients in group C were given nitroglycerin CH; ARTY, Hb, HCT, MAP, CVP, blood loss and time of conscious extubation were detected before AHH, after AHH, before CH, the time of stopping CH and the time when the operation was over. Results After AHH, ARTY and PT Showed not difference in each group（P 〉0.05）. HR during CH was lower than that before CH in Group A（P 〈 0.05）, but higher in Group C （P 〈 0.05）. CVP during CH was lower than that before CH in Group C （P 〈 0.05）, but no difference in group A（P〉0.05）. The volume of blood loss and the time of conscious extubation was no difference between the two groups （ P 〉 0.05）. Conclusion AHH combined with CH of remifentanil and sevoflurane can be used safely and effectively in hip surgery. Compared with nitroglycerin, CH of remifentanil and sevoflurane have the following benefits： slowing HR, depressing blood pressure placidly, and less influencing CVP, etc.