羟乙基淀粉行急性超容性血液稀释的临床观察

Clinical Study of Preoperative Acute Hypervolemic Hemodilution with 6% Hydroxylstarch Infusion

[目的]观察羟乙基淀粉(6%贺斯200/0.5,HES)行急性超容性血液稀释(AHHD)时血流动力学、凝血功能的变化.[方法]选择ASA Ⅰ～Ⅱ级患者50例,随机分为观察组(H组)和对照组(C组),均在气管内插管静吸复合全麻下行全髋置换手术.H组:诱导后30 min内输入羟乙基淀粉(HES)15 ml/kg.C组:输注乳酸林格液,方法同H组.当血红蛋白(Hb)低于90 g/L时输入同型异体浓缩红细胞.术中连续监测心率(HR)、血压(BP)、SpO2.分别于稀释前、稀释后即刻、稀释后1 h、术毕、术后d1及d7测定红细胞压积(HCT)、凝血功能(PT、APTT、Fib)的变化;记录术中输血量和输液量;计算出血量.[结果]术中两组患者出血量和输液量相比较差异无显著性(P>0.05),输血量及输血患者数H组明显低于C组(P<0.05).稀释后,H组MAP的变化明显低于C组(P<0.05), HR明显降低(P<0.05).H组HCT在稀释后及术中明显低于基础值及C组(P<0.05),但在术后d1和d7两组间相比差异无显著性.PT、APTI、FIB于组间、组内比较均无显著性差异(P>0.05).[结论]羟乙基淀粉行AHHD用于血液保护是安全有效的,可有效维持血流动力学平稳,提高对失血的耐受性.

[Objective]To investigate the feasibility of preoperative acute hypervolemic hemodilution（AHHD） with 6% Hydroxylstarch infusion. [Methods]Fifty ASA Ⅰ- Ⅱ patients were randomized into two groups：group H and group C. Group H was infused with 6% Hydroxyl starch（HES） at a rate of 15 ml/kg before induction. Group C was replaced with Lactate-Ringers solution. Intraoperative MAP, HR and SpO2 were monitored. HCT,PT,APTT ,Fib were measured before and after AHHD,at the end of operation, 1 d and 7 d after operation. The volume of fluid infusion, the volume of blood loss and bank-blood infusion were recorded. [Results]There were no significant differences in PT, APTT, Fib before and after AHHD between the two groups. The volume of fluid infusion and blood loss were similar, but the blood transfusion cases and the volume of bank-blood usage reduced significantly in group H（ P 〈0.05）. Compared with those in group C, HR reduced significantly（ P 〈0.05） ; the MAP less changed （ P 〈0.05） ; HCT decreased markedly after AHHD and during surgery in group H（ P 〈0.05）,but without significant differences in the first and seventh postoperative day（ P 〉0.05）. [Conclusion]Preoperative AHHD is feasible to stablize hemodynamics and reinforce the tolerance to blood loss.