急性高容量血液稀释联合控制性低中心静脉压对脊柱后路手术患者 炎症免疫调节及血液保护作用研究.

Objective:To investigate the effects of acute hypervolemic hemodilution (AHH) combined with control low central venous pressure (CLCVP) on inflammation,immune regulation and blood protection in patients undergoing posterior spinal operation.Methods:120 patients who were underwent posterior spinal operation in Nanjing Drum Tower Hospital from January 2020 to December2022 were selected as the research objects,patients were divided into control group,AHH group and AHH+CLCVP group according to the random number table method,with 40 cases in each group.Control group was given lactated Ringer’s solution hemodilution,AHH group was given AHH blood management,and AHH+CLCVP group was given AHH combine with CLCVP blood management.The changes of perioperative indexes,hemodynamic indexes,inflammatory factors indexes and immune function indexes were compared in three groups.Results:The intraoperative blood loss and suspended red blood cell transfusion volume in AHH+CLCVP group were lower than those in AHH group and control group (P＜0.05),the intraoperative blood loss and suspended red blood cell transfusion volume in AHH group were lower than those in control group (P＜0.05).Compared with T1time point,the heart rate (HR) in three groups increased first and then decreased at 60 min after the start of operation (T2)～the end of operation (T3)(P＜0.05),and the mean arterial pressure(MAP) decreased first and then increased (P＜0.05),the central venous pressure (CVP) in control group and AHH group increased first and then decreased at T2～T3(P＜0.05),and the CVP in AHH+CLCVP group remained stable at T0～T3(P＞0.05).HR in AHH+CLCVP group was lower than that in AHH group and control group at T2～T3(P＜0.05),MAP was higher than that in AHH group and control group (P＜0.05),CVP was lower than that in AHH group and control group (P＜0.05),HR in AHH group was lower than that in control group at T2～T3(P＜0.05),MAP was higher than that in control group (P＜0.05).Compared with T1time,the levels of serum procalcitonin (PCT),C-reactive protein (CRP) and interleukin-6 (IL-6) in three groups,peripheral blood CD8+increased first and then decreased at T2～24h after operation (T4)(P＜0.05),peripheral blood CD3+,CD4+,CD4+/CD8+decreased first and then increased at T2～T4(P＜0.05).The levels of serum PCT,CRP,IL-6 and peripheral blood CD8+in AHH+CLCVP group were lower than those in AHH group and control group at T2～T4(P＜0.05),and the levels of peripheral blood CD3+,CD4+and CD4+/CD8+were higher than those in AHH group and control group (P＜0.05),the levels of serum PCT,CRP,IL-6 and peripheral blood CD8+in AHH group were lower than those in control group at T2～T4(P＜0.05),and the levels of peripheral blood CD3+,CD4+and CD4+/CD8+were higher than those incontrol group(P＜0.05).Conclusion: AHH combined with CLCVP can stabilize hemodynamics, reduce intraoperative blood loss and blood transfusion, reduce inflammatory response and improve immune function in patients undergoing posterior spinal operation. [ABSTRACT FROM AUTHOR]