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目的:探讨急性高容量血液稀释(AHH)联合控制性降压(CH)对全髋关节置换患者异体输血和脑氧代谢的影响.方法:选取行全髋关节置换术的择期手术患者138例,按照数字列表法将患者随机分为对照组、AHH组、AHH+CH组,每组46例.AHH组和AHH+CH组于麻醉诱导前以20 ml· kg· h的速率静脉输注130/0.4羟乙基淀粉130/0.4,对照组输注乳酸林格氏液(6～8)ml·kg·h-1.AHH+CH组在手术开始后经静脉泵注硝酸甘油行控制性降压.记录3组患者术中出血量、尿量、异体输血率及异体输血量.分别于术前即刻(T0)、手术开始后15 min(T1)、手术开始后45 min(T2)和术毕(T3)时分别抽取颈内静脉血、桡动脉血,用血气分析仪进行血气指标分析.结果:①与对照组比较,AHH组术中尿量增多,异体输血率及输血量减少(P＜0.05);AHH+CH组术中尿量增多,术中出血量、异体输血率及输血量减少(P＜0.05).与AHH组比较,AHH+CH组术中出血量、输血率及输血量减少(P＜0.05).②与T0和对照组比较,T1～T3时AHH组和AHH+CH组动脉-颈内静脉血氧含量差(Da-j vO2)、脑氧摄取率(CERO2)明显下降(P＜0.05),但AHH+CH组下降幅度高于AHH组(P＜0.05).结论:AHH联合CH应用可明显减少全髋关节置换患者术中失血量及异体血输注量,明显降低脑氧代谢率,有利于维持脑氧供需失衡.“,”Objective:To explore the influence of acute hypervolemic hemodilution (AHH) combined with controlled hypotension (CH) on allogeneic blood transfusion and cerebral oxygen metabolism in the patients with total hip arthroplasty.Method:A total of 138 patients with total hip arthroplasty were enrolled in this study.All patients were randomly divided into control group,AHH group and AHH +-CH group according to the digital list method,46 cases in each group.The patients in AHH group and AHH+-CH group were received intravenous infusion of 6 ％ hydroxyethyl starch 130/0.4 at 20 ml/(kg · h) before anesthesia induction,with expanding capacity of 20 ml/kg,and the patients in control group were received intravenous infusion of sodium lactate ringer solution at 6-8 ml/(kg · h).The patients in AHH+ CH group were received intravenous infusion of nitroglycerin for controlled hypotension after the start of the operation.The amount of blood loss and urine output,the ratio and amount of allogeneic blood transfusion were recorded in three groups.Blood samples were taken from the internal jugular vein and radial artery for blood gas analyses at preoperative (T0),15 min after surgery (T1),45 min after surgery (T2) and the end of surgery (T3).Result:(①) Compared with control group,the urine output increased,the ratio and amount of allogeneic blood transfusion decreased(P＜0.05) in AHH group,the urine output increased,the amount of intraoperative blood loss,the ratio and amount of allogeneic blood transfusion decreased (P＜0.05) in AHH+CH group.Compared with AHH group,the amount of intraoperative blood loss,the ratio and amount of allogeneic blood transfusion decreased in AHH+CH group (P＜0.05).②) Compared with T0 and control group,the levels of Da-jvO2 and CERO2 decreased in AHH group and AHH+CH group (P＜0.05),and the falling ranges of Da-jvO2 and CERO2 in AHH+-CH group were higher than those in AHH group(P＜0.05).Conclusion:AH H combined with CH could reduce significantly the ratio and amount of allogeneic blood transfusion in total hip arthroplasty,decrease obviously cerebral metabolic rate of oxygen,which might be beneficial to maintain cerebral oxygen supply and demand imbalance.