中国组织工程研究 ›› 2010, Vol. 14 ›› Issue (4): 748-751.doi: 10.3969/j.issn.1673-8225.2010.04.042

• 骨与关节临床实践 clinical practice of the bone and joint • 上一篇    下一篇

上颌骨LefortⅠ型截骨中高渗氯化钠羟乙基淀粉40注射液的应用

蒋  超,姜  虹   

  1. 上海交通大学医学院附属第九人民医院麻醉科,上海市  200011
  • 出版日期:2010-01-22 发布日期:2010-01-22
  • 通讯作者: 姜 虹,上海交通大学医学院附属第九人民医院麻醉科,上海市 200011
  • 作者简介:蒋 超★,女,1979年生,上海市人,在读硕士。 jc3242@sina.com

Application of hypertonic solution chloride hydroxyethyl 40 injection in maxilla Lefort Ⅰ osteotomy

Jiang Chao, Jiang Hong   

  1. Department of Anesthesiology, Shanghai Ninth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai  200011, China
  • Online:2010-01-22 Published:2010-01-22
  • Contact: Jiang Hong, Department of Anesthesiology, Shanghai Ninth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China
  • About author:Jiang Chao★, Studying for master’s degree, Department of Anesthesiology, Shanghai Ninth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China jc3242@sina.com

摘要:

背景:随着日益严重的血液污染问题和输血相关疾病,血液保护的课题受到了国内外的广泛关注。
目的:观察高渗氯化钠羟乙基淀粉40注射液(高渗晶胶液)用于上颌骨LefortⅠ型截骨前急性高容量血液稀释的血液保护作用。
方法:40例患者随机分为实验组和对照组,每组20例。均采用气管插管全麻,实验组于麻醉后切皮前输入高渗晶胶液       4 mL/kg以10 mL/min的速度输注,于30 min内完成。对照组则不作任何处理。分别于急性高容量血液稀释前(T0)、急性高容量血液稀释后(T1)、急性高容量血液稀释后30 min(T2),60 min(T3),3 h(T4)、术后1 d(T5)、术后3 d(T6)抽血查血常规(包括红细胞压积、血红蛋白、血小板计数)及凝血功能(包括血小板、部分凝血活酶时间、纤维蛋白原),并记录术中输血量、输液量、出血量及尿量。
结果与结论:40例患者均进入结果分析。与对照组相比,实验组的输注异体血数量较少(P < 0.05),尿量较多(P < 0.05);两组患者术中输液量及失血量差异无显著性意义(P > 0.05)。两组患者行控制性降压后,T2、T3的心率较T1明显升高(P < 0.05),T2、T3的收缩压、舒张压、平均动脉压较T1明显降低(P < 0.05)。在T1、T2、T3时间点,实验组心率较对照组明显升高(P < 0.05)。两组患者的中心静脉压各时间点差异均无显著性意义(P > 0.05)。经过急性高容量血液稀释后T1、T2、T3、T4时间点,实验组血红蛋白、血球压积较对照组明显降低(P < 0.05);血小板计数、部分凝血活酶时间较对照组明显延长(P < 0.05)。T1、T2时间点,实验组Na+ 、Cl-较对照组明显升高(P < 0.05);T5、T6时间点,实验组的血红蛋白、血球压积较对照组明显升高(P < 0.05)。提示高渗晶胶液用于上颌骨LefortⅠ型截骨前急性高容量血液稀释可明显减少或避免输注异体血。

关键词: 氯化钠羟乙基淀粉40, 高渗, 高容量, 血液稀释, 全髋置换

Abstract:

BACKGROUND: Hematic protective has arisen widely attention in China and abroad due to the serious blood contamination and transfusion related diseases.  
OBJECTIVE: To observe hematic protective effect of hypertonic solution chloride hydroxyethyl 40 injection (HSH) on acute hypervolemic hemodilution (AHH) in maxilla Lefort Ⅰ osteotomy.
METHODS: Totally 40 patients were randomly divided into the experimental and control groups, with 20 patients in each group. All patients were operated under tracheal intubation general anesthesia. In the experimental group, 4 mL/kg HSH was infused with speed of 10 mL/min, and the infusion was finished within 30 minutes. There was no treatment in the control group. Blood routine examination (including hematocrit, hemoglobin, blood platelets count) and routine coagulation test (including platelet, partial thromboplastin time, fibrinogen) was performed at the points of before AHH (T0), at the end of AHH (T1), 30 min after AHH (T2),  60 min after AHH (T3), 3 hours after AHH (T4), 1 day after operation (T5), and 3 days after operation (T6), respectively. Simultaneously, the capacities of blood transfusion, liquor transfusion, hemorrhage and urine during operation was recorded.
RESULTS AND CONCLUSION: All the patients were included in the final analysis. Compared to the control group, the capacity of blood transfusion in the experimental group was smaller than that of the control group (P < 0.05), with greater urine volume (P < 0.05). However, the differences of liquor transfusion and hemorrhage had no significance (P > 0.05). After controlled hypotension, the heart rates of patients at T2 and T3 were obvious increased than that of T1 (P < 0.05), the systolic pressure, diastolic pressure, and mean arterial pressure were significantly decreased (P < 0.05). At T1, T2 and T3 points, the heart rates of patients in the experimental group were greater than that of the control group (P < 0.05). The systolic pressure, diastolic pressure, and mean arterial pressure had no dramatically differences between two groups (P > 0.05). After AHH, the hematocrit and hemoglobin were obviously decreased in the experimental group at T1, T2, T3 and T4 points (P < 0.05), with more blood platelets count and prolonged partial thromboplastin time (P < 0.05). Compared to the control group, the Na+ , Cl- was increased in the experimental group at T1 and T2 points (P < 0.05), with greater hematocrit and hemoglobin at the T5 and T6 points (P < 0.05). The results demonstrated that HSH can decrease or avoid transfusing blood in maxilla Lefort Ⅰ osteotomy.

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