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目的:探讨急性等容性血液稀释(ANH)联合控制性降压(CH)对异位妊娠手术患者异体输血及安全性的影响。方法:选择2015-01-2016-08妇产科异位妊娠破裂伴出血性休克患者72例,按照数字列表法将患者随机分为ANH+CH组和ANH组,每组36例。ANH组行术中ANH,ANH+CH组在ANH基础上行CH。观察2组ANH前、后,手术开始后30min及术毕时的平均动脉压(MAP)、中心静脉压(CVP)、心率(HR)等。记录2组术中失血量、异体输血量及尿量。结果:与ANH组比较,ANH+CH组MAP在ANH后即刻、ANH后30min及术毕时降低(P<0.05),而HR在ANH后即刻、ANH后30min升高(P<0.05),但均在正常范围内。2组不同时间节点CVP比较差异无统计学意义(P>0.05)。ANH+CH组术中出血量和异体输血量均明显少于ANH组,差异有统计学意义(P<0.05)。结论:ANH与CH联合应用于异位妊娠手术,可维持患者血流动力学的稳定,减少异体输血,具有更有效的血液保护效应和安全性。
Objective: To investigate the effect of acute isovolemic hemodilution (ANH) combined with controlled hypotension (CH) on allogeneic transfusion and safety in patients undergoing ectopic pregnancy. Methods: Seventy-two patients with hemorrhagic shock with rupture of gynecology and ectopic pregnancy were selected from January 2015 to August 2016. The patients were randomly divided into ANH + CH group and ANH group according to the digital list method, with 36 cases in each group. ANH group intraoperative ANH, ANH + CH group on the basis of ANH CH. The mean arterial pressure (MAP), central venous pressure (CVP) and heart rate (HR) of the two groups before and after ANH were observed at 30 min after operation and at the end of operation. Two groups of intraoperative blood loss, allogeneic blood transfusion and urine output were recorded. Results: Compared with ANH group, the MAP of ANH + CH group decreased immediately after ANH, 30 min after ANH and at the end of operation (P <0.05), while HR increased immediately after ANH and 30 min after ANH (P <0.05) All within the normal range. There was no significant difference in CVP between two groups at different time points (P> 0.05). The blood loss and blood loss in ANH + CH group were significantly less than those in ANH group (P <0.05). Conclusion: The combined application of ANH and CH in ectopic pregnancy can maintain hemodynamic stability and reduce allogeneic blood transfusion, with more effective blood protection and safety.