Abstract
Objective To observe the volume of intra-operative cell salvage (ICS) and its corresponding effect on the plasma colloid osmotic pressure(COP) and pulmonary function of the patient.Methods Patients scheduled for the spinal surgery during general anesthesia were enrolled and divided into 3 groups according to the volumes of blood loss and ICS:Group A (ICS ≤ 250 mL),Group B (ICS 251-500 mL) and Group C (ICS＞500 mL).All patients received general anesthesia and mechanical ventilation after intubation(VT =8 mL/kg,RR =10-18/min,I/E =1∶2).BP,HR,ECG,SpO2,CVP,PETCO2,blood gas analysis,plasma colloid osmotic pressure(COP) and the Peak airway pressure were measured and monitored during the surgery.Blood salvage was performed with heparin anti-coagulation and washed,centrifuged and collected using a sterile bag,and then the red blood cells were transfused before the end of surgery.Fluid was infused according to the intra-operative hemodynamics,and the liquids consisted of compound sodium chloride and 6％ hyroxyethyl starch 130/0.4 at the ratio of 1.5 ∶ 1.Respiration rate,electrolyte and acid-base balance were adjusted based on the blood-gas analysis.The change of hemodynamics,ventilation parameters and COP were measured at the following time points:before anesthesia induction(T0),after anesthesia induction(T1),before the skin cut(T2),before autologous blood transfusion(T3),15min after transfusion(T4) and the end of surgery(T5).Dynamic pulmonary compliance,alveolar arterial blood oxygen difference (PA-aDO2) and oxygenation index(PaO2/FiO2) were calculated based on the respiration parameters and blood gas analysis.Results 1.COP:Intra-group comparison:For group A,no significant difference was found at any of the time points observed(P＞0.05).For group B and C,COP were significantly decreased at T3,T4,T5 (B/C:20.7± 1.9/18.0± 1.8,19.0± 2.1 / 17.3± 1.8,19.6 ± 2.4/17.t ± 2.9) (P＜ 0.05) while no significant difference was seen in T1 and T2 (P＞ 0.05) as compared with that at T0(23.0±2.5/23.1±2.1).Inter-groups comparison:For T0,T1 and T2,no significant difference was found among the 3 groups(P＞0.05).For T3,T4 and T3,the COP values in group B (20.7±1.9,19.0±2.1,19.6±2.4) was lower than that in group A (21.6±2.1,21.3± 1.9,22.0±2.2),and the COP in group C (18.0± 1.8,17.3± 1.8,17.1± 2.9) was the lowest compared to the other two (P＜0.05,respectively).2.PA-aDO2 and PaO2/FiO2:Intra-group comparison:For group A,PA-aDO2 and PaO2/FiO2 no significant difference was found at any of the time points observed(P＞0.05).For group B (160.8± 30.7/335.1 ± 30.6,165.1 ± 31.2/347.0± 35.8,158.9± 33.7/351.1 ± 36.8) and C (240.1 ± 41.5/ 229.0±26.6,267.9±45.5/249.1±25.5,251.8±40.6/248.1±22.7),PA-aDO2 was significantly increased at T3,T4,T5(P ＜0.05,respectively),while PaO2/FiO2 was decreased as compared with that at T1 (144.7±21.9/473.4±44.6)respectively (P＜0.05,respectively).Inter-groups comparison:For T1 and T2,no significant difference was confirmed among the 3 groups(P＞0.05,respectively).For T3,T4 and T5,PA-aDO2 was higher while PaO2/FiO2 was lower in group B than that in group A (P＜0.05,respectively).In addition,PA-aDO2 in group C was higher than that in group B and A,while PaO2/ FiO2 was lower compared the other two groups (P＜0.05,respectively).3.Lung compliance:Intra-group comparison:For group A and B,lung compliance at T2 、T3 、T4 、Ts showed no significant difference when compared with that at T1(P＞0.05).For group C,lung compliance at T2 、T3 、T4 、T5(40.2±6.3、39.1±5.0、40.3±6.6)was decreased than that at T1(49.9±9.8) (P＜0.05).Inter-groups comparison:For T1 and T2,no significant difference was observed among the 3 groups(P＞0.05).For T3,T4 and T5,lung compliance was significantly decreased in group C(40.2±6.3,39.1±5.0,40.3±6.6) as compared to group B(44.3±5.1,44.2±5.9,50.7±7.7) and A(44.6±5.8,45.0±5.5,53.2±7.9) (P＜0.05,respectively).Conclusion Intra-operative blood loss and autologous blood transfusion (＞250 mL) resulted in the reduction in plasma colloid osmotic pressure and oxygenation capacity.Autologous blood transfusion (＞500 mL) would further reduce the lung compliance apart from the decreased COP and oxygenation capacity.Massive autologous blood transfusion necessitated the infusion of plasma or albumin simultaneously to increase the plasna colloid osmotic pressure.关键词
骨科手术/血液回收/输血,自体/胶体渗透压,血浆/肺功能Key words
orthopedic surgery/blood salvage/blood transfusion, autologous/plasma colloid osmotic pressure/pulmonary function分类
医药卫生
