急性等容血液稀释联合控制性降压用于肝脏肿瘤切除术的临床研究

Acute normovolemic hemodilution combined with controlled hypotension in patients undergoing liver tumorectomy

目的探讨急性等容血液稀释(ANH)联合控制性降压在肝脏肿瘤切除术中对减少输注异体血量的影响,从而评价其术中安全性。方法择期肝脏肿瘤切除术病人30例,随机分为3组:ANH组(A组)、ANH加控制性降压组(B组)和对照组(C组),每组10例。3组病人均采用气管插管全麻,A组和B组在麻醉诱导后手术开始前行ANH,且B组在肝脏肿瘤切除时段加行控制性降压,C组行常规输血补液。观察3组病人术中所输异体血量、术后血红蛋白和红细胞压积的变化。结果C组术中每例均输注异体血平均为(664.8±248.1)ml;A组有6例未输异体血,4例输异体血平均为400ml;B组则全部未输注异体血;3组病人间输注异体血量有显著性差异(P<0.01)。3组病人术中血流动力学基本平稳。结论ANH联合控制性降压可安全用于肝脏肿瘤切除术,可避免或减少输注异体血量,是一种安全有效的节约血源的方法,值得推广应用。

Objective To evaluate the effects of acute normovolemic hemodilution （ANH） combined with controlled hypotension on reducing heterogeneous transfusion and safety during liver tumorectomy. Methods Thirty patients undergoing elective liver tumorectomy were randomly divided into 3 groups （10 each）, namely ANH group （group A）, ANH combined with controlled hypotension group （group B） and control group （group C）. All the patients were anesthetized via endotracheal intubation. Before the operation, ANH was performed in groups A and B after anesthesia induction, and controlled hypotension was initiated in group B during tumorectomy. Blood transfusion and fluid infusion were carried out routinely in group C. Hb and Hct were measured before operation, after ANH, and immediately, 1 day and 7 days after the operation. The difference in intraoperative blood loss and heterogeneous blood transfusion volume in the 3 groups was observed. Results In group A, heterogeneous blood transfusion was avoided in 6 cases and but given in the other cases for an average of 400 ml. In group C, every patient received heterogeneous blood transfusion （664.8 ±248.1 ml）, but none of the patients received heterogeneous blood in group B. The difference in transfusion volume between the 3 groups was significant （P〈0.01）. Hemodynamics was basically stable during operation in the 3 groups. Conclusion ANH combined with controlled hypotension is safe and effective for decreasing and even avoiding homologous blood transfusion in liver tumorectomy.