Influences of AHH combined with CH on plasma CRP and IL-6 levels in patients with THA
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摘要: 目的：探讨急性高容量血液稀释（AHH）联合控制性降压（CH）对全髋关节置换（THA）患者C反应蛋白（CRP）、白细胞介素-6（IL-6）水平的影响。方法：选取2015-03-2018-03行全髋关节置换术患者90例，随机分为A组、B组和C组，每组30例。麻醉平稳后，A组以30 ml/min的速率静脉输入6%羟乙基淀粉，实施AHH；B组在AHH基础上给予硝酸甘油0.5~5.0 μg（/kg·min）行CH；C组不实施AHH和CH。记录3组手术时间、术中失血量、尿量和输血量。记录羟乙基淀粉输注前（C组为手术前30 min，T0）、羟乙基淀粉输注后（C组为手术开始时，T1）、手术开始后2 h（T2）、手术结束时（T3）、术后24 h（T4）血浆CRP、IL-6水平。结果：①B组术中失血量明显少于A组、C组（P<0.05），A组、B组尿量明显多于C组（P<0.05），A组、B组输血量明显少于C组（P<0.05），B组输血量明显少于A组（P<0.05）。②与T0比较，T2~T4时3组CRP、IL-6水平显著升高（P<0.05），A组和B组T1~T4时CRP、IL-6水平均显著低于C组（P<0.05），A组和B组T1~T4时CRP、IL-6水平比较差异无统计学意义（P>0.05）。结论：AHH联合CH不仅可显著减少全髋关节置换术患者术中失血及异体输血，而且可有效抑制围术期CRP、IL-6的表达水平。Abstract: Objective: To explore the influence of acute hypervolemic hemodilution(AHH) combined with controlled hypotension(CH) on CRP and IL-6 levels in patients with total hip arthroplasty(THA).Method: 90 cases of patients with THA were enrolled in this study.All patients were divided randomly into group A(n=30), group B(n=30) and group C(n=30).The patients in group A were infused 6% hydroxyethyl starch 130/0.4(6% HES 130/0.4) at a rate of 30 ml/min after anesthesia, the patients in group B were received CH with nitroglycerin at a rate of 0.5-5.0 μg/(kg·min) on the basis of AHH, and AHH and CH did not implemented in group C.Operation time, intraoperative blood loss, amount of urine and blood transfusion were recorded in three groups.The plasma CRP and IL-6 levels before hydroxyethyl starch infused(30 min before surgery in group C, T0), after hydroxyethyl starch infused(at the beginning of surgery in group C, T1), 2 h after the start of surgery(T2), at the end of surgery(T3) and 24 h after surgery(T4) were recorded in three groups.Result: ① Intraoperative blood loss in group B was less significantly than that in group A and group C(P<0.05), urine volume in group A and group B were more significantly than that in group C(P<0.05), blood transfusion amount in group A and B group were less obviously than that in group C(P<0.05), and blood transfusion amount in group B was less significantly than that in group A(P<0.05).② Compared with T0, CRP and IL-6 levels at T2-T4 increased significantly in three groups(P<0.05), CRP and IL-6 levels at T1-T4 in group A and group B were lower significantly than those in group C(P<0.05), and CRP and IL-6 levels at T1-T4 between group A and group B had no statistical significance(P>0.05).Conclusion: AHH combined with CH can reduce significantly intraoperative blood loss and allogeneic blood transfusion in patients with THA, and restrain effectively perioperative expression levels of CRP and IL-6.
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