急性高容量血液稀释联合控制性降压对全髋关节置换患者CRP、IL-6的影响
|
摘要
目的:探讨急性高容量血液稀释(AHH)联合控制性降压(CH)对全髋关节置换(THA)患者C反应蛋白(CRP)、白细胞介素-6(IL-6)水平的影响。方法:选取2015-03—2018-03行全髋关节置换术患者90例,随机分为A组、B组和C组,每组30例。麻醉平稳后,A组以30 ml/min的速率静脉输入6%羟乙基淀粉,实施AHH;B组在AHH基础上给予硝酸甘油0.5～5.0μg(/kg·min)行CH;C组不实施AHH和CH。记录3组手术时间、术中失血量、尿量和输血量。记录羟乙基淀粉输注前(C组为手术前30 min,T_0)、羟乙基淀粉输注后(C组为手术开始时,T_1)、手术开始后2 h(T_2)、手术结束时(T_3)、术后24 h(T_4)血浆CRP、IL-6水平。结果:①B组术中失血量明显少于A组、C组(P<0.05),A组、B组尿量明显多于C组(P<0.05),A组、B组输血量明显少于C组(P<0.05),B组输血量明显少于A组(P<0.05)。②与T_0比较,T_2～T_4时3组CRP、IL-6水平显著升高(P<0.05),A组和B组T_1～T_4时CRP、IL-6水平均显著低于C组(P<0.05),A组和B组T_1～T_4时CRP、IL-6水平比较差异无统计学意义(P>0.05)。结论:AHH联合CH不仅可显著减少全髋关节置换术患者术中失血及异体输血,而且可有效抑制围术期CRP、IL-6的表达水平。
Objective:To explore the influence of acute hypervolemic hemodilution(AHH)combined with controlled hypotension(CH)on CRP and IL-6 levels in patients with total hip arthroplasty(THA). Method:90 cases of patients with THA were enrolled in this study.All patients were divided randomly into group A(n=30),group B(n=30)and group C(n=30).The patients in group A were infused 6% hydroxyethyl starch 130/0.4(6% HES 130/0.4)at a rate of 30 ml/min after anesthesia,the patients in group B were received CH with nitroglycerin at a rate of 0.5-5.0 μg/(kg·min) on the basis of AHH,and AHH and CH did not implemented in group C.Operation time,intraoperative blood loss,amount of urine and blood transfusion were recorded in three groups.The plasma CRP and IL-6 levels before hydroxyethyl starch infused(30 min before surgery in group C,T_0),after hydroxyethyl starch infused(at the beginning of surgery in group C,T_1),2 h after the start of surgery(T_2),at the end of surgery(T_3)and 24 h after surgery(T_4)were recorded in three groups. Result:① Intraoperative blood loss in group B was less significantly than that in group A and group C(P<0.05),urine volume in group A and group B were more significantly than that in group C(P<0.05),blood transfusion amount in group A and B group were less obviously than that in group C(P<0.05),and blood transfusion amount in group B was less significantly than that in group A(P<0.05).② Compared with T_0,CRP and IL-6 levels at T_2-T_4 increased significantly in three groups(P<0.05),CRP and IL-6 levels at T_1-T_4 in group A and group B were lower significantly than those in group C(P<0.05),and CRP and IL-6 levels at T_1-T_4 between group A and group B had no statistical significance(P>0.05).Conclusion:AHH combined with CH can reduce significantly intraoperative blood loss and allogeneic blood transfusion in patients with THA,and restrain effectively perioperative expression levels of CRP and IL-6.
Objective:To explore the influence of acute hypervolemic hemodilution(AHH)combined with controlled hypotension(CH)on CRP and IL-6 levels in patients with total hip arthroplasty(THA). Method:90 cases of patients with THA were enrolled in this study.All patients were divided randomly into group A(n=30),group B(n=30)and group C(n=30).The patients in group A were infused 6% hydroxyethyl starch 130/0.4(6% HES 130/0.4)at a rate of 30 ml/min after anesthesia,the patients in group B were received CH with nitroglycerin at a rate of 0.5-5.0 μg/(kg·min) on the basis of AHH,and AHH and CH did not implemented in group C.Operation time,intraoperative blood loss,amount of urine and blood transfusion were recorded in three groups.The plasma CRP and IL-6 levels before hydroxyethyl starch infused(30 min before surgery in group C,T_0),after hydroxyethyl starch infused(at the beginning of surgery in group C,T_1),2 h after the start of surgery(T_2),at the end of surgery(T_3)and 24 h after surgery(T_4)were recorded in three groups. Result:① Intraoperative blood loss in group B was less significantly than that in group A and group C(P<0.05),urine volume in group A and group B were more significantly than that in group C(P<0.05),blood transfusion amount in group A and B group were less obviously than that in group C(P<0.05),and blood transfusion amount in group B was less significantly than that in group A(P<0.05).② Compared with T_0,CRP and IL-6 levels at T_2-T_4 increased significantly in three groups(P<0.05),CRP and IL-6 levels at T_1-T_4 in group A and group B were lower significantly than those in group C(P<0.05),and CRP and IL-6 levels at T_1-T_4 between group A and group B had no statistical significance(P>0.05).Conclusion:AHH combined with CH can reduce significantly intraoperative blood loss and allogeneic blood transfusion in patients with THA,and restrain effectively perioperative expression levels of CRP and IL-6.
引文
[1]张艳杰,解永强,赵顺来,等.急性高容量血液稀释联合控制性降压对全髋关节置换患者异体输血和脑氧代谢的影响[J].临床血液学杂志,2017,30(12):944-947.
[2]周海洲,黄倩洁,蒋晖.不同程度急性高容量血液稀释对老年病人凝血功能和全身炎性反应的作用[J].蚌埠医学院学报,2018,43(4):471-474.
[3]李振威,解金三,陈锋,等.骨感染患者血清TNF-α与IL-6和CRP水平变化的研究[J].中华医院感染学杂志,2018,28(4):559-562.
[4]姜则,梁华,丁志刚,等.急性高容量血液稀释联合控制性降压对老年脊柱手术患者术后认知功能的影响[J].西北国防医学杂志,2015,36(9):578-581.
[5]龚亚娜,解永强,赵顺来,等.AHH联合CH对老年全髋关节置换患者血流动力学及CTnI的影响\[J\].临床血液学杂志,2017,30(12):965-968.
[6]袁利邦,景调平,贺雅琳,等.急性高容量血液稀释联合控制性降压对脊柱手术围术期血液保护的研究[J].西北国防医学杂志,2015,36(1):4-7.
[7]熊华平,吴志云,查本俊.急性高容量血液稀释联合控制性降压用于全髋关节置换术患者的临床观察[J].临床军医杂志,2015,43(11):843-847.
[8]赵国文,赵兴昌,崔拥国,等.6%羟乙基淀粉预扩容对颅脑外伤患者围术期血流动力学及炎症因子的影响[J].海南医学院学报,2016,22(24):3065-3069.
[9]张红梅,宋阳,邹明,等.骨科重症创伤患者血清白介素-6、肿瘤坏死因子-α、高敏C反应蛋白水平联合检测的临床价值分析[J].标记免疫分析与临床,2018,25(9):1331-1334.
[10]王继辉,张庆.急性高容量血液稀释联合控制性降压对脊柱手术患者全身炎性反应的影响[J].临床麻醉学杂志,2015,31(2):148-150.
[11]王彩霞,段启瑞,王莹,等.急性高容量血液稀释对下肢缺血-再灌注损伤病人外周血细胞因子的影响[J].内蒙古医科大学学报,2018,40(5):508-510.
[2]周海洲,黄倩洁,蒋晖.不同程度急性高容量血液稀释对老年病人凝血功能和全身炎性反应的作用[J].蚌埠医学院学报,2018,43(4):471-474.
[3]李振威,解金三,陈锋,等.骨感染患者血清TNF-α与IL-6和CRP水平变化的研究[J].中华医院感染学杂志,2018,28(4):559-562.
[4]姜则,梁华,丁志刚,等.急性高容量血液稀释联合控制性降压对老年脊柱手术患者术后认知功能的影响[J].西北国防医学杂志,2015,36(9):578-581.
[5]龚亚娜,解永强,赵顺来,等.AHH联合CH对老年全髋关节置换患者血流动力学及CTnI的影响\[J\].临床血液学杂志,2017,30(12):965-968.
[6]袁利邦,景调平,贺雅琳,等.急性高容量血液稀释联合控制性降压对脊柱手术围术期血液保护的研究[J].西北国防医学杂志,2015,36(1):4-7.
[7]熊华平,吴志云,查本俊.急性高容量血液稀释联合控制性降压用于全髋关节置换术患者的临床观察[J].临床军医杂志,2015,43(11):843-847.
[8]赵国文,赵兴昌,崔拥国,等.6%羟乙基淀粉预扩容对颅脑外伤患者围术期血流动力学及炎症因子的影响[J].海南医学院学报,2016,22(24):3065-3069.
[9]张红梅,宋阳,邹明,等.骨科重症创伤患者血清白介素-6、肿瘤坏死因子-α、高敏C反应蛋白水平联合检测的临床价值分析[J].标记免疫分析与临床,2018,25(9):1331-1334.
[10]王继辉,张庆.急性高容量血液稀释联合控制性降压对脊柱手术患者全身炎性反应的影响[J].临床麻醉学杂志,2015,31(2):148-150.
[11]王彩霞,段启瑞,王莹,等.急性高容量血液稀释对下肢缺血-再灌注损伤病人外周血细胞因子的影响[J].内蒙古医科大学学报,2018,40(5):508-510.
© 2004-2018 中国地质图书馆版权所有 京ICP备05064691号 京公网安备11010802017129号 地址：北京市海淀区学院路29号 邮编：100083 电话：办公室：(+86 10)66554848；文献借阅、咨询服务、科技查新：66554700 |