抑肽酶血液麻醉在关节置换外科手术中应用.doc

抑肽酶血液麻醉在关节置换外科手术中应用 　【摘要】 目的探讨抑肽酶血液麻醉在关节置换外科手术中的使用价值及对凝血功能的影响。方法60例择期行骨科关节置换手术病例，随机分为两组。实验组30例，在麻醉诱导后静注抑肽酶200万KIU后持续泵注抑肽酶50万KIU /h，直至手术后结束停药；对照组30例，持续泵注生理盐水。分别在术前、木毕、术后6 h、24 h时间点上抽血检测血常规、血栓弹性描记图（TEG）、凝血功能指标。比较两组病人的出血量、输血量及TEG和凝血功能变化。结果在使用了抑肽酶之后，手术时间明显缩短；两组手术出血量及输异体血量比较,有非常显著性差异(P＜0.01)。抑肽酶对A组的Fib、TEG指标无显著性影响（P＞0.05）。结论抑肽酶血液麻醉可明显减少关节置换外科手术的出血量，减少异体血的输入，且不影响凝血功能，值得推广应用。 【关键词】 抑肽酶 麻醉 关节置换 Aprotinin blood anesthesia used in joint replacement Abstract: Objective To investigate the role of aprotinin blood anesthesia used in the joint replacement and the effect on the blood coagulable function. Methods Patients undergoing joint operation were randomly divided into two groups. Experiment group (Agroup, 30 patients) was injected with 200 panKIU aprotinin and pumped with 50panKIU/h until operation finished. The contrast group (Bgroup, 30 patients) was treated with 0.9%NS. The venous blood was withdrawal for blood routine, thrombelastography and coagulable function at the time of preoperative, 6h and 12h post operation. The change of TEG and coagulable state were monitored during the whole surgery, and the volume of transfusion and hemorrhage between two groups was contrasted. Results In experiment group, the operative time was shorten obviously, and the volume hemorrhage and transfusion was obviously less(P＜0.01). aprotinin did not influence the Fib and TEG in Agroup(P＞0.05). Conclusions Aprotinin blood anesthesia can reduce the volume of hemorrhage and transfusion and not influence the coagulable function. It is worth using in the joint replacement operation. Keywords: aprotinin; anesthesia; joint replacement 血液保护是外科发展的必然要求，如何减少术中出血及输血，防止输血传播性疾病及输血反应对机体的危害日益为麻醉医师所关注。“血液麻醉”是体外循环下血液保护的特殊手段，本文探讨抑肽酶血液麻醉在关节置换外科手术中进行血液保护的可行性及对凝血功能的影响，旨在进一步拓宽抑肽酶血液麻醉的使用范围。 1资料与方法 1.1临床资料 选择60例择期骨科关节置换手术患者，男性34例，女性26例，年龄44～66岁。经过内科调理后术前心电图、血常规、肝肾功能基本正常。采用双盲法试验，随机分为试验组30例和对照组30例。 1.2麻醉方法　 术前常规肌注苯巴比妥钠0.1 g、阿托品0.5 mg。麻醉诱导：静脉给予芬太尼2 μg/kg、氟哌啶0.1 mg/kg、异丙酚2 mg/kg、维库溴铵0.12 mg/kg、佩尔地平0.02 mg/