急性等容性血液稀释对肝脏手术纤维蛋白降解产物D-二聚体和凝血功能的影响

Effects of acute normovolemic hemodulition on fibrin degradation product DD and coagulation function during hepatic surgery

目的探讨急性等容性血液稀释(ANH)对肝脏手术纤维蛋白降解产物D二聚体和凝血功能的影响。方法肝脏手术患者60例随机均分为三组,Ⅰ组行ANH,红细胞压积(Hct)为30%;Ⅱ组行ANH,Hct为25%;Ⅲ组为对照组不行ANH。所有行ANH患者均经肘部静脉或其他大静脉采血,放血时间为15～30min,血液存于含PCD的采血袋;下肢同步输注等容量6%羟乙基淀粉(HES),直到Hct降至30%或25%,并维持血液动力学稳定。所采集的血液室温保存于手术室,结合术中失血量和循环情况在手术结束前行自体输血;分别于ANH前、ANH后30、60min、手术结束和手术后12h采静脉血测定血小板计数(Plt)、凝血酶原时间(PT)、凝血酶时间(TT)、纤维蛋白降解产物D二聚体和Hct。结果Ⅰ、Ⅱ组术中出血量较Ⅲ组显著减少(P<0.05);Ⅰ、Ⅱ组ANH后和术中PT、TT较Ⅲ组显著延长(P<0.05,P<0.01),Plt显著下降(P<0.05,P<0.01),但仍在正常范围内,回输自体血后上述指标明显恢复,手术野和切口无异常出血;三组D二聚体无明显改变(P>0.05)。结论术前对肝脏手术患者进行ANH至Hct降至30%～25%之间是安全的,对凝血功能和纤溶系统无明显影响且可减少术中出血量。

Objective To evaluate the effects of acute normovolemic hemodilution（ANH） on the fibrin protein degradation product DD and coagulation during hepatic surgery. Methods Sixty ASA Ⅰ -Ⅱ patients scheduled for hepatic surgery were divided into three groups with 20 cases each. The patiants in group Ⅰ were hemodiluted to Hct of 30% ,those in group Ⅱ were hemodiluted to Hct of 25% ,and those in group Ⅲ were taken as a control group. Hemodilution was carried out by removal of blood from elbow vein within 15-30 min and replacement with same volume of 6% HES. Pit, PT, TT,fibrin product DD and Hct were measured before ANH,at 30 and 60 min after ANH,the end of operation, 12 h after operation. Results The surgical bleeding was significantly less in group Ⅰ and Ⅱ than that in group Ⅲ（P〈0.05）. PT and TT prolonged and pit decreased more significantly after hemodilution in group Ⅰ and group Ⅱ than those in group Ⅲ ,but which were still within the normal range. DD had no significant change in three groups. Conclusion ANH of Hct 0.25 to 0.30 during hepatic surgery is safe with no significant enfluence on coagulation function.