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目的探讨立芷雪结合血液稀释与控制性降压用于脑膜瘤手术的安全性和临床效果。方法择期开颅脑膜瘤切除患者80例,随机分为A、B、C、D 4组(n=20)。A组:术前静注立芷雪2 kU,麻醉诱导期30 min内输入6%羟乙基淀粉130/04.20 ml/kg,联合美托洛尔复合硝酸甘油控制性降压;B组:美托洛尔联用硝酸甘油;C组:术前静注立芷雪2 kU,D组(对照组):常规补液处理。4组分别于麻醉前(基础值T0)、手术切皮时(血液稀释后T1)、手术开始60 min(T2)和术毕即刻(T3)测定血红蛋白(Hb)、红细胞压积(Hct)、血小板(Plt)、纤维蛋白原(Fib)、部分凝血活酶时间(APTT)及凝血酶原时间(PT)。并监测MAP、HR、CVP等变化。结果 A组血液稀释后Hb、Hct、Plt及Fib明显下降,CVP明显升高(P<0.05);但在T2、T3时段Hb、Plt均明显高于其他3组(P<0.05)B组降压期间CVP、MAP降低(P<0.05),但A、B 2组术中HR基本稳定于T0水平(P>0.05);C、D 2组APTT、PT术中虽稍有降低,但组内与组间比较差异均无显著性(P>0.05);A组术中失血量和输血量均明显少于B组、C组及D组(P<0.01)。结论立芷雪结合扩容性血液稀释与控制性降压用于脑膜瘤切除术可明显减少术中出血量和异体输血量,且对凝血功能无明显影响。
Objective To investigate the safety and clinical effect of Li Zhi Xue combined with hemodilution and controlled hypotension in meningioma surgery. Methods Eighty patients with elective craniotomy were randomly divided into A, B, C and D 4 groups (n = 20). Group A: Preoperative intravenous injection of Lizhi Xue 2 kU, 30% of the induction of anesthesia during the importation of 6% hydroxyethyl starch 130 / 04.20 ml / kg, metoprolol combined nitroglycerin controlled hypotension; B group: the United States Tolol with nitroglycerin; Group C: preoperative intravenous injection of Lizhi Xue 2 kU, D group (control group): conventional rehydration. The changes of hemoglobin (Hb), hematocrit (Hct), blood pressure and blood pressure before anesthesia (basal value of T0), skin incision (T1 after hemodilution), 60 min (T2) Platelet (Plt), fibrinogen (Fib), partial thromboplastin time (APTT) and prothrombin time (PT). And monitoring MAP, HR, CVP and other changes. Results The levels of Hb, Hct, Plt and Fib in group A decreased significantly and CVP increased significantly (P <0.05). However, the levels of Hb and Plt in group T2 and T3 were significantly higher than those in other three groups (P <0.05) The HR of CVP and MAP in group A and group B were stable at T0 (P> 0.05), while the level of CVP and MAP in group C and D 2 were slightly decreased (P <0.05) There was no significant difference between the two groups (P> 0.05). The blood loss and blood transfusion in group A were significantly less than those in group B, C and D (P <0.01). Conclusion Li Zhi Xue combined with dilated hemodilution and controlled hypotension for meningioma surgery can significantly reduce intraoperative blood loss and allogeneic transfusion volume, and no significant effect on the coagulation function.