目的：探讨自体血液回收联合控制性降压技术对减少异体输血的价值，并分析其对脊柱外科手术患者脑组织氧合及乳酸代谢的影响。方法2013年1月-2014年12月间纳入80例脊柱外科手术患者，随机均分为两组院观察组予自体血液回收联合控制性降压；对照组常规自体血液回收。对比两组围手术期出入量，统计计算术前、术后即刻、术后24 h血红蛋白（Hb）水平、脑氧耗[C（a-jv）O2]、脑氧摄取率（CERO2）、动静脉血样乳酸含量差（ADVL）、持续性降压稳定时平均动脉压。结果两组术中失血量、引流量、尿量差异无统计学意义（P>0.05），但观察组异体输血量明显低于对照组（P<0.05）；两组术前Hb接近（P>0.05），但术后即刻、24 h观察组Hb明显高于对照组（P<0.05）；两组术前C（a-jv）O2、CERO2及ADVL无明显差异（P>0.05），但术后即刻、24 h观察组CERO2明显低于对照组（P<0.05）；观察组术中MAP稳定值明显低于对照组（P<0.05）。结论自体血液回收和控制性降压是减少异体输血量的有效措施，其有助于改善脊柱外科手术患者脑氧摄取率，但不会影响脑乳酸代谢。%Objective To investigate the value of autologous blood recovery combined with controlled hypotension technology in reducing allogeneic blood transfusion, and analyze its effect on brain tissue oxygenation and lactic acid metabolism in patients with spinal surgery. Methods 80 cases with spinal surgery admitted from January 2013 to December 2014 were randomly and equally divided into two groups, the observation group and the control group. The observation group were given autologous blood recovery combined with controlled hypotension, while the control group were given conventional autologous blood recovery. The intake and output of the two groups in peri-operation were compared. The hemoglobin (Hb), cerebral oxygen consumption level [C (a-jv)O2], cerebral oxygen extraction rate (CERO2), arteriovenous blood lactic acid content (ADVL) before operation, immediately after and 24h after operation were counted and calculated and compared. The mean arterial pressure (MAP) after stable was also compared. Results The volume of blood loss, drainage and urine during operation between the groups showed no significant difference (P>0.05), but the volume of allogeneic blood transfusion in the observation group was significantly less than that in the control group (P<0.05). Before operation the Hb of the two groups were similar(P>0.05), but immediately after operation and 24h after operation, Hb in the observation group was significantly higher than that in the control group(P<0.05). The preoperative C(a-jv)O2, CERO2 and ADVL in the two groups showed no significant difference (P>0.05). But the CERO2 immediately after operation and 24h after operation in the observation group was significantly lower than that in the control group (P<0.05). The stable MAP during the operation of the observation group was lower than that of the control group(P<0.05). Conclusion The combination of autologous blood recovery and controlled hypotension is an effective measure for decreasing the amount of transfusion, which contributes to the improvement of cerebral oxygen extraction rate in patients with spinal surgery. And it also shows no effects on the brain lactic acid metabolism.
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