急性等容血液稀释用于肝叶切除术的临床研究

The clinical observation of acute normovolemic hemodilution in patient undergoing hepatectomy

目的 :探讨急性等容血液稀释 ( ANHD)用于肝叶切除术中对减少输异体血量及术后 Hb和 Hct的影响。方法 :择期肝叶切除术患者 40例 ,随机分成稀释组 ( 组 ,n=2 0 )和对照组 ( 组 ,n=2 0 ) ,两组皆采用气管内插管全麻。 组术前进行急性等容血液稀释 ,手术结束前回输自体血 , 组按常规处理。于术前、术中 ( ANHD后 )、术毕、术后第 1天和术后第 7天分别测定血红蛋白 ( Hb)、红细胞比容 ( Hct)变化 ,并比较两组患者围术期出血量、尿量和补液输异体血量的差异。结果 :两组患者围术期出血量接近 , 组有 1 3例完全避免输异体血 ,余 7例各输异体血 2 0 0 ml; 组每例患者均输异体血 ,输血量 480± 1 80 ml,显著多于 组 ( P<0 .0 1 )。两组输液量差异有统计学意义 ( P<0 .0 5 )。Hb、Hct 组血液稀释后较术前均显著降低 ( P<0 .0 1 ) ,术毕 组和 组的 Hb、Hct均显著低于术前 ( P<0 .0 1 ) ,并且 组明显低于 组 ( P<0 .0 5 ) ,术后第 1天、术后第 7天两组患者的 Hb、Hct仍显著低于术前 ,但两组比较无显著性差异 ( P>0 .0 5 )。结论 :急性等容血液稀释可使肝叶切除术患者少输或不输异体血 ,是一种安全有效、节约血源的方法。

Objective:To investigate the effects of acute normovolemic hemodilution (ANHD)on post-operational Hb and Hct and on reducing heterogeneous transfuaion during hepatectomy.Methods:40 cases with hepatectomy were randomly divided into two groups:ANHD groups(group one,n =20) and control group(group two,n =20).All patients were anesthetized with endotracheal intubation anesthesis.Hemodilution was accomplished pre-operationly and autologous blood was transfused post-operationly. Hb and Hct were measured before operation,after ANHD,during operation,1d and 7d after operation.The difference of intraoperative blood loss and heterogeneous blood to be transfused during operation between two groups was observed.Results:Blood loss in the pastents of group one was almost the same compared with group two.In the group one ,heterogeneous blood was avoided in 13 cases and heterogeneous blood transfused in the other cases was 200ml for each.In group two,however,every case received heterogeneous blood 480±180ml,which was significantly more than that of group one( P <0.01). The difference of transfusional volume between two group was significant( P <0.05). Hb and Hct of patients in groups one after hemodilution were significantly lower than those before operation. Hb and Hct of patients in two group after operation were significantly higher than those before operation( P <0.01),and Hb and Hct of patients in group one were significantly lower than those in group two( P <0.05). Hb and Hct of patients in two groups on the first and seventh day after operation were lower than those before operation,but there was not difference between two groups( P >0.05).Conclusion:This result suggests that acute isovolemic hemodilution in hepatectomy is a safe and effective method to decrease and even avoid the need of homologous blood.