手术患者急性非等容量血液稀释与急性高容量血液稀释的比较

Comparison of acute non- isovolemic hemodilution(ANIH) and acute hypervolemic hemodilution(AHH) during surgery

目的评估手术患者使用急性非等容血液稀释(ANIH)和急性高容量血液稀释(AHH)的安全性和有效性。方法36例成年手术患者,ASAⅠ￣Ⅱ级,随即分两组:ANIH组(16例),AHH组(20例)。均采用硬膜外复合全麻。ANIH组诱导前采自体血400ml,诱导同时两组患者快速补充晶体液和胶体液各500ml,术中监测MAP、HR、CVP、Hct,手术结束前自体血回输患者(ANIH)组。术中Hct低于25%时输异体血。结果两组患者围术期生命体征稳定,均达到血液稀释的目的;AHH组CVP升高较ANIH组明显。术毕时和术后第1天的Hct,ANIH组较AHH组高(P<0.05)。结论ANIH组和AHH组都可达到血液稀释的目的,并对循环系统无不良影响,符合手术患者血液保护的要求,安全有效。ANIH组在血液保护和减低高容量负荷方面优于AHH组。

Objective The purpose of this study was to evaluate the safety and effectiveness of ANIH in comparison with AHH in patients undergoing operations. Methods Thirty-six mature patients with ASA Ⅰ - Ⅱ ,undergoing selective surgery were randomly divided into two groups： ANIH group （n=16） and AHH group （n=20）.The operations were performed under combined general-epidural anesthesia. In each group, 400 ml of blood was removed before induction of anesthesia.The removed blood was reinfused at the end of the operation.500 ml of colloid or 500 ml of crystalloid solution were infused to patients in each group when induction of anesthesia started. Vital signs（MAP,HR, CVP）and haematocrit （Hct） Were monitored during operations. Blood transfusion was considered when Hct below 25%. Results The vital signs were fairly stable during perioperative period in both groups.The purpose of hemodilution was both achieved. The increase of CVP in AHH group was higher than that in ANIH group.Hct in ANIH group was remarkably higher than that in AHH group at the end of the operation and the first day after surgery. Conclusion ANIH and AHH are safe and effective techniques to achieve the purpose of hemodilution without adverse effect on circulatory function. ANIH is safer and more effective in blood preservation and reducing the hypervolemic pressure.