不同血液保护法对节约手术用血的效果

目的比较三种不同血液保护法用于手术,节约用血效应和安全性。方法ASAⅠ～Ⅱ级,估计手术出血量>800ml的择期手术患者60例,随机分为3组,每组各20例:A组单纯行术前等容血液稀释;B组行术前超容血液稀释复合术中控制性降压;C组行术前等容血液稀释复合术中控制性降压。观察各组各时点血流动力学、血液流变学变化,准确估计手术出血量、计算扣除血液稀释因素后实际失血量。结果3组放血、扩容后血流动力学相对稳定,无肺水肿、心力衰竭、异常出血等临床征象,术毕C组血常规测定Hb、Hct高于A、B组,手术失血量估计B、C组少于A组,术后翌日排除血液稀释因素后,Hct计算实际失血量值,B、C组少于A组,扩容后凝血功能测定PT、APTT、TT略延长,但未影响创面凝血。结论超容血液稀释联合控制性降压减少的实际失血量近乎与等容血液稀释联合控制性降压组相当,优于单纯等容血液稀释组,其操作简便、不需在术前放血储血、无血液污染等危险,更适合在基层医院推广。

Objective To compare the effect and safety of concerving blood with three methods of blood maintaining for operation. Methods 60 ASA Ⅰ～Ⅱ patiends tmderging selective operation with the intraoperative blood loss predicted to exceed 800 ml were randomly divided into three groups （ n = 20） . Patient＇s blood was diluted with equatvolemic hemodilution in group A, with hypervolemic emodilution in group B accompanied by deliherate hypotension during operation; with equatvolemic hemodilution accompanied by deliherate hypotension during operation in group C. Observe the change of hemodynamics and hemorheology in different time in three groups and precise evaluate the valume of bleeding . Results It is relative stable in three groups on hemodynamics and no clinical sign of pulmonary edema,heart failure and abnormal bleeding. It is more high in the value of Hb, Hct preoperative blood routine in group c than group A and B. The value of bleeding during operatin in group B and C was less than that in group A. At the same time the actual valume of blood loss after operation except for the factor of dilution in group B and C was less than that in group A. Concliusion The actual valume of blood loss with hypervolemic hemodilution accompanied by deliherate hypotension is correspondent to that of equatvolemic hemodilution accompanied bydeliherate hypotension , but superior to that of only with equatvolemic hemodilution. It is suitable for backgrotmd hospital to perform hypervolemic hemodilution.