急性非等容量血液稀释对直肠癌患者循环及凝血功能的影响

Effects of Acute Non-isovolemic Hemodilution on Hemodynamics and Blood Coagulation in Patients with Rectal Cancer

目的观察急性非等容量血液稀释(ANIH)对直肠癌患者围术期循环及凝血功能的影响.方法择期直肠癌根治术(Mile’s)患者30例,年龄40～65岁,体重50～75 kg,随机均分为C组(n=15):对照组,术中常规输液,术毕输异体少白细胞红细胞2 U;A组:ANIH组,于麻醉诱导前采血400～600 mL(循环血量的10%～15%),然后快速输入羟乙基淀粉(HES130/0.4)1 000～1 200 mL,并于手术结束前将自体血回输.术中监测平均动脉压(MAP)、心率(HR)、中心静脉压(CVP),分别于麻醉前1 h(T1)、稀释后(T2)、术毕即刻(T3)术后第1天(T4)抽取静脉血,测定Hct和凝血功能(PT、APTT、FIB).结果稀释后A组CVP明显升高,与基础值和C组比差异均有统计学意义(P<0.05),诱导时2组患者均有一过性低血压,但C组较A组降低明显(P<0.05),术中A组尿量较C组明显增多(P<0.05).稀释后A组Hct、FIB明显降低,APTT明显延长,与基础值和C组比差异均有统计学意义(P<0.05);术毕及术后1 d A组Hct、PT、APTT与C组比差异无统计学意义(P>0.05),术毕A组FIB明显低于C组(P<0.05).结论 ANIH能增加循环功能的稳定性,可有效减少术中异体血输入,对凝血功能无明显影响.

Objective To evaluate the effects of acute non-isovolemic hemodilution(ANIH)on hemodynamics and blood coagulation in patients with rectal cancer.Methods Thirty ASA physical statusⅠ-Ⅱpatients aged 40～65 yr,weighing 50～75 kg,Duckes stage B-C,undergoing elective rectal cancer surgery were randomly divided into two groups(n=15):group C(control group,received 400 mL white cell-reduced allogenic red blood cells transfusion at the end of operation) and group A(acute non-normolvolemic hemodilution group).In group A 400～600 mL of blood(about 10%～15% of BV)was removed and then Hydroxyethyl starch(HES130/0.4)1 000～1 200 mL was infused before induction.The operation were performed under combined general-epidural anesthesia.Vital signs(MAP,HR and CVP changes)were monitored during operation and venous blood samples were taken before surgery,after hemodilution,the end of surgery and the 1 d after operation for determination of Hct,PT,APTT and FIB.Results The CVP of patients in A group was obviously higher than that of group C after hemodilution and there were transient hypotention developed during induction of anesthesia in two groups,but the decrease of MAP in group C was significantly lower than that in group A(P<0.05).The volume of urine during operation in group C was significantly less than that in group A(P<0.05).After hemodilution,Hct and FIB significantly decreased and APTT prolonged markedly in group A(P<0.05).There was no significantly difference in Hct,PT and APTT at the end of surgery and 1d after operation between two groups(P>0.05).After hemodilution and at the end of surgery FIB in group A was significantly lower than that in group C(P<0.05).Couclusion ANIH can improve the stablization of circulatory function and reduce the blood transfusion,it has little influence on blood coagulation.