急性等容血液稀释联合回收式自体输血在非停搏冠状动脉旁路移植术中的应用

EFFECT OF MODERATELY ACUTE NORMOVOLEMIC HEMODILUTION COMBINED WITH INTRAOPERATIVE AUTOLOGOUS TRANSFUSION O N THE PATIENTS UNDERGOING OFF-PUMP CORONARY ARTERY BYPASS

①目的研究急性等容血液稀释(ANH)联合回收式自体输血疗法对非停搏冠状动脉旁路移植术(OPCAB)病人血液保护的效果.②方法 40例择期行OPCAB病人,随机分成ANH联合回收式自体输血组(联合组)和回收式自体输血组(对照组),联合组病人麻醉诱导后从动脉采血(采血量8～12 mL/kg),同时从静脉输入胶体液加晶体液(V:V=1:1).两组病人用血液回收机回收的术中出血,术中或术毕将洗涤后的红细胞均回输体内.联合组在此基础上将术前采集的自体血回输体内.监测两组病人术中血流动力学变化,术前及术后24 h血红蛋白(Hb)、血细胞比容(Hct)、血小板计数(PLT),24 h出血量及输异体血的量.③结果两组病人术后24 h Hb、Hct、PLT、出血量、术后输异体血的量比较差异有显著性(t=2.281～9.878,P<0.05、0.01).④结论 ANH联合回收式自体输血能降低OPCAB病人异体血的输注,降低术中及术后输血量.

Objective To study the effect of moderately acute normovolemic hemodilution （ANH） combined with intraoperative autologous transfusion （IAT） on patients undergoing off-pump coronary artery bypass grafting. Methods Forty patients undergoing off-pump coronary artery bypass grafting were randomly allocated to one of two groups： Combined group （ANH＋IAT, n=20） or controlled group （IAT, n=20）. In Combined group moderate ANH involved withdrawal of blood （8-12 mL/kg） after anesthesia induction, while isovolemia was maintained with the infusion of colloid and crystalloid （V ： V= 1 ： 1）. During operation cell saver was used to retransfuse shed red blood cell. In controlled group during operation only cell saver was used to retransfuse shed red blood cell. Haemodynamic index, haemoglobin amount of shed （Hb）, hematocrit （Hct）, the amount of platelet （PLT） before and 24 h after operation, the amount of shed blood and transfusion of conserved blood were determined. Results At 24 h after operation, there was a significant difference in Hb, Hct, PLT and the amount of shed blood and transfusion of conserved blood （t=2.281 9.878; P〈0.05, 0.01）. Conclusion Moderate ANH combined with IAT can reduce the quantity of foreign blood transfusion of patients undergoing off pump coronary artery bypass grafting.