摘要
目的 观察比较术前急性超容性血液稀释 (AHH )和急性等容性血液稀释 (ANH )作为血液保护技术在肝肿瘤手术病人的临床应用。方法 选择 45例ASAI -II级肝肿瘤手术病人 ,随机分为对照组 (n =15 ) ,超容性血液稀释组 (n =15 )和等容性血液稀释组 ( n=15 )。在麻醉诱导后 ,AHH组患者静脉快速滴注 2 0ml/kg液体 ,ANH组病人采血 15ml/kg保存体外同时输入等量 6%羟乙基淀粉。术中监测包括血压 ,心率 ,ECG ,氧饱和度 ,尿量 ,输液量和失血量。在血液稀释前后 ,手术结束和术后一天采血测定下列指标 :血红蛋白、红细胞压积、血小板 ,血液生化指标 ,凝血酶原时间 (PT)、激活凝血活酶时间 (APTT)。结果 AHH和ANH两组患者血液稀释后Hct分别由血液稀释前 ( 3 9 8± 3 4) %和 ( 4 0 2± 3 5 ) %下降到 ( 3 0 9± 3 3 ) %和 ( 2 9 6± 2 8) % ,血液稀释后AHH和ANH两组患者PT和APTT均有明显延长 (P <0 0 5 )。但是两组患者血液动力学稳定 ,血液生化指标无明显变化 ,与对照病人相比术中出血量无显著差异。AHH ,ANH和对照组分别有 4,3 ,9例患者需要输入异体血 ,对照组患者需要输入异体血总量明显多于AHH和ANH组 (P <0 0 5 )。结论 在ASAI
Objective To compare the effect of acute hypervolemic hemodilution (AHH) and normovolemic hemodilution (ANH) as means of perioperative blood conservation in the patients undergoing hepatic tumor operation. Methods 45 ASA I-II patients with hepatic tumor were randomly divided into three groups, control, AHH and ANH, each group containing 15 cases. After induction of anesthesia, the patients of AHH group were rapidly infused 20 ml/kg fluid intravenously, the patients of ANH group were withdrawn 15ml/kg intravenous blood and simultaneously infused the same volumes of 6% hydroxyethyl starch. BP, HR, ECG, SaO2, urine output, fluid input and blood loss were monitored during operation. Blood samples were collected before and after hemodilution, at end of operation and the first day of postoperation to measure Hb, Hct, Plt, blood biochemical indices, PT and APTT. Results After hypervolemic and normovolemic hemodilution Hct reduced to 30.9±3.3% and 29.6±2.8% from 39.8±3.4% and 40.2±3.5% respectively, and PT and APTT were significantly prolonged in both the AHH and ANH patients (P<0.05). However, all patients maintained hemodynamic stable without significant changes in blood biochemical indices. Also there were no significant differences in blood loss among AHH, ANH and control groups. There were 4, 3 and 9 patients in AHH, ANH and control groups required homologous blood transfusion respectively. The total volumes of homologous blood transfusion in control group were significant more than those in both AHH and ANH groups (P<0.05). Conclusion Preoperative acute hypervolemic and normovolemic hemodilution as means of perioperative blood conservation has similar effects in decreasing homologous blood transfusion in patients undergoing hepatic tumor operation, however hypervolemic hemodilution is more simple and saving time.
出处
《中国医师杂志》
CAS
2004年第4期451-453,共3页
Journal of Chinese Physician
基金
广东省卫生厅科研基金立项课题 (A2 0 0 1 4 36)
