急性等容性血液稀释在外科手术中的应用

The application of acute normovolemic hemodilution in surgical operations

目的:探讨急性等容性血液稀释在外科手术中的应用及机制。方法:将36例ASAⅠ～Ⅱ级并符合纳入标准的择期外科手术患者随机分为两组:稀释组(ANHD组)和对照组,每组18例。稀释组患者施行急性等容性血液稀释时按公式V=EBV×(Ho-Hf)/Hav估算放血量,放血的同时输入1∶1等量的胶体溶液及0.5∶1的晶体溶液,在手术结束前或术中明显出血时回输放出的自体血。对照组行常规手术。结果:稀释组患者术中输入的异体血量明显减少。结论:急性等容性血液稀释在外科手术中能节约库血,减少血源性传染病,减轻患者经济负担,其疗效确切,效果好,值得推广。

Objective: To investigate the application and mechanism of acute normovolemic hemodilution (ANHD) in surgical operations. Methods: Thirty-six ASA Ⅰ-Ⅱ patients scheduled for surgical operations were randomly divided into two groups: ANHD group (group, n=18) and controlled group (group Ⅱ, n=18). In ANHD group the volume of blood withdrawn was estimated by the following formula: V=EBV×(H\-0-H\-f)/H av . Hemodilution was achieved by drainage of arterial blood and simultaneously intravenous infusion of an equal volume (1∶1) of colloid and half volume (0.5∶1) of crystalloid to maintain intravascular volume. If significant surgical blood loss occurred or it was near the end of the operation, the transfusion of blood obtained by hemodilution could begin. In controlled group the operations were performed as usual. The continuous basic fluid infusion during operations in controlled group was the same as that in ANHD group. Results: The volume of homologous blood transfused in ANHD group was significantly lower than that in controlled group. Conclusion: ANHD can effectively reduce the need for homologous blood transfusion and the accompanying risk of transfusion-related infection and transfusion reactions. This technique is a useful, banked blood-saved, efficient and cost-effective blood conservation strategy.