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1、不同容量治疗方案对硬膜外麻醉下急诊骨科手术患者效果比较[摘要]目的:探讨不同容量治疗方案对硬膜外麻醉下急诊骨科手术患者治疗效果的影响。方法:收集急诊骨科手术患者100例,随机分为两组。两组患者一般情况比较,差异无统计学意义,具有可比性。所有患者进行硬膜外麻醉,高容量血液稀释组快速输入6%羟乙基淀粉;对照组常规输液。比较两组MAP、HR、CVP、Hct及Hb的变化情况。结果:Ⅰ组患者MAP、HR变化与术前比较,差异无统计学意义;CVP略有增高,但在正常范围内。Ⅱ组患者术后与术前比较MAP、CVP降低,HR
2、增快。Ⅰ组患者术后与术前比较,Hb、Hct略有降低;Ⅱ组患者术后Hb、Hct明显降低,与术前比较,差异有统计学意义。结论:急性高容量血液稀释,可提高急诊骨科手术患者对失血的耐受性,对维持手术患者机体内环境稳态有积极意义,操作简便、安全有效。[关键词]骨科手术;麻醉;血液稀释[中图分类号]R614.4+2[文献标识码]A[文章编号]1674-4721(2010)07(a)-044-02Treatmentofdifferentcapacityonemergencyorthopedicsurgeryunder
3、epiduralanesthesiainpatientscomparison6NONGJiazhen1,LUOJianxing2,LUMingyan2(1.PanyuDistrict,GuangzhouCity,AnesthesiologyNutinGuangdongProvince,Guangzhou511480,China;2.PanyuDistrict,GuangzhouCity,LamnuclearHospitalSurgeryinGuangdongProvince,Guangzhou51148
4、0,China)[Abstract]Objective:Comparisontheeffectsonpatientsundergonebonesurgeryuseepiduralanesthesiaanddifferentcapacitytreatment.Methods:Collected100casesofemergencyorthopedicsurgerypatients,randomlydividedintotwogroups.Twogroupsofpatientsingeneralcompar
5、e,thedifferencewasnotsignificant.Allpatientswithepiduralanesthesia.Hypervolemichemodilutiongroupoffastinputof6%hydroxyethylstarch,controlgroupgiveconventionalinfusion.ComparedthreegroupsofMAP,HR,CVP,HctandHbchanges.Results:ⅠgroupofMAP,HRcomparedwiththepr
6、eoperativedifferencewasnotstatisticallysignificant;CVPincreasedslightly,butwithinthenormalrange.ⅡgrouppatientscomparedwiththepreoperativeMAP,CVP6decreased,HRfaster.Ⅰgroupwerecomparedwithpreoperative,Hb,Hctdecreasedslightly;ⅡgroupofpatientsHb,Hctdecreased
7、significantlycomparedwiththepreoperative,thedifferencewasstatisticallysignificant.Conclusion:Acutehypervolemichemodilutioninpatientsundergoingorthopedicsurgerycanimprovetheacutetolerancetobloodloss,surgicalpatientsonthebodytomaintainhomeostasisarepositiv
8、e,simple,safeandeffective.[Keywords]Orthopaedics;Anesthesia;Hemodilution骨科手术创伤大,围术期失血多,从而易引起术中低血压,影响患者血流动力学的稳定,降低各重要脏器的供氧[1];过去临床上常采取异体输血的方法补充术中血容量的不足,但此方法易发生免疫反应,因此,临床上尽量避免异体输血。近年来,急性高容量血液稀释(AHH)技术不断运用于骨科手术,此方法可以减少患者异体输血并
