摘要
目的探讨术中维持较低的血红蛋白水平对患者手术过程和手术预后的影响。方法 ASAⅠ或Ⅱ级手术患者120例,随机分为Ⅰ、Ⅱ和Ⅲ3组,每组各40例,术中血红蛋白(Hb)浓度分别为:100g≤Hb<120g/L、80g≤Hb<100g/L和70g≤Hb<80g/L。测定术前(T0)、术中(T1)、术毕(T2)、术后24h(T3)、出院时(T4)的血常规、乳酸、动脉血气,观察上述时点的心率(HR)、平均动脉压(MAP)变化情况,记录术中总输血量及输血并发症的发生情况、手术时间、住院时间及手术预后等。结果各组红细胞(RBC)、血红蛋白(Hb)及红细胞比容(Hct)在T1～T3时均低于T0,同期比较Ⅱ组低于Ⅰ组,Ⅲ组又低于Ⅱ组;T4时这些指标与T0比较差别减少,同时3组之间比较差异也减少。3组T1～T3的乳酸含量高于T0,T4虽仍高于组T0,但差距已明显缩小,组间同期比较无明显差异。3组T1～T3的pH、二氧化碳分压(PaCO2)低于T0,至T4时与T0已无差异。pH、PaCO2及其氧分压(PaO2)各组同期比较差异无统计学意义。每组各时点及组间同期HR、MAP差异无统计学意义。Ⅰ组的输血量及比Ⅱ、Ⅲ组多,Ⅱ又明显多于Ⅲ组。Ⅰ组因输血导致的过敏反应、发热多于Ⅲ组。3组间的住院时间无差别。3组患者术后切口感染及延迟愈合发生率无差别。结论术中Hb维持在70～80g/L水平对患者是安全的,且能减少术中输血量和因输血导致的不良反应。
Objective To investigate the influence of the low hemoglobin concentration during intraoperative procedures on the operative security and postoperative recovery.Methods One hundred and twenty ASA Ⅰ or Ⅱ patients scheduled operation under general anesthesia were randomly divided into three groups（n=40 each）：group I,group Ⅱ and group Ⅲ.Hemoglobin（Hb） concentration of the intraoperative procedures was 100 g≤Hb120 g/L,80 g≤Hb100 g/L and 70 g≤Hb80 g/L in the three groups,respectively.Arterial blood samples were obtained before（T0）,during（T1）,at the end of（T2）,24 h after（T3） surgery and when discharging from the hospital（T4） for normal blood analysis,blood lactate levels and blood gas analysis.At the same time,the changes of heart rate（HR） and mean arterial pressure（MAP） were measured.The amount of blood transfusion and the complication rate of blood transfusion during surgery,operation time,in-hospital time and postoperative recovery states were recorded.Results RBC,Hb and Hct were significantly decreased at T1-compared with T0.At T1-3,they were significantly lower in group Ⅱ than in group Ⅰ and significant lower in group Ⅲ than ingroup Ⅱ.At T4,these differences became small between the three groups.The blood lactate value was significantly higher at T1-3 as compared with the baseline at T0.Although these differences existed still at T4,they became less,at most times there were no significant difference at the same time among the three groups.About pH and PaCO2 they were significantly lower in these three groups at T1-3 than at T0,at T4 thry retuned to the baseline at T0.The level of pH 、PaCO2 and PaO2 was no significant difference at the same time among the three groups.No significant MAP existed at all times in these three groups and among the three groups.The differences of HR and amount of blood transfusion was significant in group Ⅰ than group Ⅱ or Ⅲ,and it was significant in group Ⅱ than in group Ⅲ.During surgery,the rates of allergy and fever due to blood transfusion were significantly higher in group Ⅰ than group Ⅲ.The time of in-hospital was not significant difference among the three groups.Meanwhile no significant differences in the complication rates of incisional wound infection and delay healing among the three groups were observed.Conclusion The patiens are safe when Hb maintain 80-100 g/L during surgery.Furthermore,at this Hb level,the amount of blood transfusion and the complications of blood transfusion during surgery can be reduced.
出处
《检验医学与临床》
CAS
2012年第6期673-675,共3页
Laboratory Medicine and Clinic
关键词
血红蛋白
输血
手术
预后
hemoglobin
blood transfusion
operative procedures
postoperative recovery
