急性高容量血液稀释与急性等容量血液稀释的临床比较

Comparative clinical effects of acute hypervolemic hemodilution and acute normovolemic hemodilution

目的比较急性高容量血液稀释(AHH)与急性等容量血液稀释(ANH)在节约用血中的临床效果。方法68例椎管减压内固定术的患者,随机分为两组:急性等容量血液稀释(ANH)组(n=30),术前采集每公斤体重15ml的自体血,同时输入每公斤体重22.5ml的琥珀酰明胶(GEL);急性高容量血液稀释(AHH)组(n=38),术前输入每公斤体重22.5ml的琥珀酰明胶,但不采集自体血,用吸入异氟醚来避免血管内容负荷过高。分别于麻醉前,血液稀释后,术毕后和术后1、2、3d采血检测Hb、HCT、PLT、PT、APTT、FLB,记录两组患者MAP、HR、采血量、失血量、回收血量、异体输血量和血液稀释所需时间、耗材和设备。结果两组一般情况差异无统计学意义。两组术中失血量、术后失血量、血红蛋白、血球压积、血小板、凝血功能以及异体输血率差异均无统计学意义(P>0.05)。ANH组平均动脉压在血液稀释后明显下降(P<0.05)。两组总耗时比较,P<0.05。结论使用AHH比ANH简单、省时、节约和减少污染机会,更有利于循环稳定。

Objective To evaluate the clinical effect of acute hypervolemic hemodilution and acute normovolemic hemodilution in economy with clinical blood infusion. Methods 68 patients with vertebrate tube decompression were divided into two groups randomly： acute hypervolemic hemodilution group （n = 38 ） and acute normovolemic hemodilution group（ n = 30 ）. The each kilogram weight 15ml body blood were collected before operations and input the each kilogram weight 22.5ml gelofusine at the same time in ANH group. The each kilogram weight 22.5ml gelofusine were infused and body blood was not collected from the body blood, used to inhale the isoflurane to avoid the afferent contents burden measuring high. The blood examination of Hb, HCT, PLT, PT, APTT, FLB were implemanted before the anaesthesia,after the blood dilution, time of the surgical operation be over and after operation finish 1,2,3 days respectively. MAP, HR, the amount adopting of blood, the amount losing of blood, the amount of recovering blood, the different body blood transfusion quantity, the hemodilution need and consuming the material and equipmentses were recorded. Results Two general circumstance did not show the obvious difference. There were no statistic difference among the losing amount of blood in operation, the losing amount of blood after operation, hemoglobin, blood cell pressure physical volume,the blood platelets, solidify the blood function and the different body blood transfusion rates（ P〉0.05）. ANH average artery pressed to descendobviously after hemodilution （ P〈0.05） ,but the AHH set had no obvious variety. （68±5）min when ANH set was total to consume,the AHH set was total to consume （33 ± 4 ）rain（ P 〈0.05）. Conclusion Using the AHH can save time, economize and reduce the opportunity to pollute, even be advantageous to the circulating stability comparing with the ANH.