文章摘要
二氧化碳气腹手术回收自体血的临床价值
Clinical value of autologous blood salvage in laparoscopic surgery
  
DOI：10.12089/jca.2018.03.012
中文关键词: 二氧化碳气腹  腹腔镜手术  自体血回收  血气分析  肝血管瘤
英文关键词: Carbon dioxide pneumoperitoneum  Laparoscopic surgery  Autologous blood salvage  Blood gas analysis  Hepatic hemangioma
基金项目:
作者单位E-mail
韩侨宇 100044,北京大学人民医院麻醉科  
冯艺 100044,北京大学人民医院麻醉科  
梁汉生 100044,北京大学人民医院麻醉科 doctorlianghsh@sina.com 
摘要点击次数: 3144
全文下载次数: 998
中文摘要:
      目的 探讨CO2气腹在腹腔镜手术中对术野回收自体血携氧功能和电解质的影响, 评价其临床应用价值, 为日后腹腔镜手术中自体血回收、回输提供参考性依据。方法 选取2016年5月至2017年8月择期行CO2气腹手术(CP组, 腹腔镜肝血管瘤手术)和非CO2气腹手术(NCP组, 脊柱手术)的患者各20例, 男18例, 女22例, 年龄 27～79 岁, BMI 21.64～24.46 kg/m2, ASA Ⅰ或Ⅱ级。两组患者均采用全身麻醉, 术中监测HR、NBP、IBP、SpO2、ECG、PETCO2、CVP、BIS和T, 应用自体血液回收机进行术野血回收、回输。分别检测两组患者储血器过滤前1 min(过滤前1 min)、储血器过滤后1 min(过滤后1 min)、回输洗涤血前10 min(回输前10 min)和回输洗涤血后10 min(回输后10 min)各血样的pH、PCO2、PO2、SO2、Hct、Hb、Lac和Na+、K+、Ca2+、Cl-、Mg2+等电解质浓度, 并记录患者手术时间、血液离体时间、出血总量、回收和回输血液总量。结果 与过滤前1 min和过滤后1 min比较, CP组回输前10 min和回输后10 min pH、PO2、SO2明显升高(P＜0.05);NCP组回输前10 min和回输后10 min pH明显降低(P＜0.05), PCO2和PO2明显升高(P＜0.05)。与NCP组比较, CP组过滤前1 min 和过滤后1 min pH、PO2和SO2明显降低, PCO2明显升高(P＜0.05);与过滤后1 min比较, CP组过滤前1 min、回输前10 min和回输后10 min Na+和Cl-浓度明显降低, K+、Ca2+和Mg2+浓度明显升高(P＜0.05);NCP组回输前 10 min和回输后 10 min Na+和Cl-浓度明显降低, K+、Ca2+和Mg2+浓度明显升高(P＜0.05)。各时点两组电解质指标差异均无统计学意义。结论 CO2气腹手术回收自体血过酸, 携氧较低, 回输后改变患者酸碱平衡, 增加酸中毒风险, 临床应用价值有待进一步探讨。
英文摘要:
      Objective To investigate the effect of carbon dioxide pneumoperitoneum on the oxygen carrying capacity and electrolyte levels in the salvaged autologous blood undergoing laparoscopic surgery. To evaluate the clinical application value and to provide guidance for the salvage and transfusion of autologous blood in laparoscopic surgery. Methods Twenty cases who underwent laparoscopic surgery (group CP, laparoscopic hepatic hemangioma surgery) and twenty cases who underwent open surgery (group NCP, spinal surgery), including eighteen males and twenty-two females, aged 27-79, BMI 1.64-24.46 kg/m2, ASA Ⅰ-Ⅱ, were selected from Peking University People′s Hospital from May 2016 to August 2017. Cases in both groups underwent general anesthesia. NBP, IBP, ECG, HR, SpO2, PETCO2, CVP, BIS and T were monitored and autologous blood salvage and transfusion were used during the operation. Arterial blood samples were collected from patients 10 min before and after autologous blood transfusion, salvaged blood samples were collected 1 min before and after filtration. Blood gas analysis, including the level of pH, PCO2, PO2, SO2, Hct, Hb, Lac and the concentrations of Na+, K+, Ca2+, Cl-, Mg2+, were performed on all blood samples. Recording operation time and blood in vitro time, blood loss volume intraoperative, total blood volume of salvage and transfusion. Results In group CP, pH, PO2 and SO2 of autologous blood 1 min before and after filtration were significantly lower than those of arterial blood 10 min before and after autologous blood transfusion (P＜0.05). In group NCP, pH of autologous blood 1 min before and after filtration was significantly higher than that of arterial blood 10 min before and after autologous blood transfusion, while PCO2 and PO2 were significantly lower than the latter (P＜0.05). PH, PO2 and SO2 of autologous blood in group CP were significantly lower while PCO2 was significantly higher than group NCP (P＜0.05). PH of arterial blood 10 min after autologous blood transfusion was significantly lower while PCO2 was significantly higher than group NCP (P＜0.05). In group CP, the concentration of Na+ and Cl- in autologous blood 1 min after filtration were significantly higher than those before filtration and the arterial blood 10 min before and after autologous blood transfusion. The concentration of K+, Ca2+ and Mg2+ in autologous blood 1 min after filtration were significantly lower than the latter three blood samples (P＜0.05). In group NCP, the concentrations of Na+ and Cl- in autologous blood 1 min after filtration were significantly higher than those in arterial blood 10 min before and after autologous blood transfusion. The concentrations of K+, Ca2+ and Mg2+ were significantly lower than those in the latter two blood samples (P＜0.05). There were no significant differences in electrolyte concentration of all blood samples between two groups. Conclusion The salvaged blood in laparoscopic surgery is superacid and carrying less oxygen. After transfusion, may change patients′ acid-base balance and increase the risk of acidosis. Its clinical application value need more further explorations.
查看全文   查看/发表评论  下载PDF阅读器
关闭