术前急性高容量血液稀释对血液流变学的影响

Effects of Acute Hypervolemic Hemodilution on Hemorheology

目的:观察急性高容量血液稀释(AHH)后血液流变学特性的变化,为临床合理应用血浆代用品提供理论依据。方法:60例脊柱手术患者随机分为3组,每组20例,按20ml/kg在手术开始前分别输注6%羟乙基淀粉、4%琥珀明胶或乳酸林格氏液扩容量,达到高容量血液稀释。检测稀释前后全血粘度、血浆粘度、Hct、红细胞聚集指数、红细胞变形指数。结果:1AHH后循环功能稳定,围手术期异体血输入量胶体液组明显少于晶体液组;2AHH后全血粘度、Hct明显降低;红细胞聚集指数降低、细胞变形指数6%羟乙基淀粉组升高。结论:术前AHH可以有效地维持术中循环功能稳定,优化血液流变状态,利于微循环灌注,提高患者对失血的耐受性,减少异体输血量,胶体溶液优于晶体溶液。

Objective:To observe the changes of hemorheology after acute hypervolemic hemodilution (AHH) in clinical practice.Methods:60 patients for selected spinal surgery were randomly divided into 3 groups (n=20) to receive intravenous infusion 20 ml/kg of 6% hydroxyethyl strach (HES)(H group),4% gelofusine(G group) or ringer's solution(R group),respectively,before surgery. The whole blood viscosity,plasma viscosity, Hct,index of RBC aggregation and index of RBC deformation were measured before and after hemodilution.Resutls:①Hemodynamics were stable after hemodilution, the amounts of blood transfusion perioperatively inthe colloid(H,G) group patients were less than that in the crystalloid (R)group;②The whole blood viscosity, Hct and index of RBC aggregation were significantly reduced after AHH in all patients;Index of RBC deformation was markedly increased in patients after AHH by 6% HES.Conclusion:AHH could effectively maintain hemodynamic stablity, improve the hemorheological status and microcirculative perfusion, enhance the tolerance of blood loss, and reduce homologous blood transfusion. Colloid could be better than crystalloid for AHH.