急性等容性血液稀释自体输血应用于舌癌手术：附2例报告

Effects of Acute Normovolemic Hemodilution on Treatment of Patients with Tongue Cancer

目的：探讨在舌癌患者手术治疗过程中应用急性等容性血液稀释(ANH)自体输血的临床效果。方法：对2例舌癌患者进行常规全麻后,经桡动脉采血,同时经外周静脉输入等量的6%贺斯进行ANH。然后行常规舌颈联合根治术+前臂皮瓣游离移植修复术,手术结束同时回输自体血。结果：对比术前、术后第1天和术后第5天的血红蛋白量、红细胞压积、血小板量以及PT、APTT,显示2例舌癌患者术后恢复良好,前臂皮瓣存活。结论：ANH自体输血可以减少或避免舌癌手术异体输血所致的并发症。ANH可以降低血液粘滞性、增加心输出量、维持组织氧供需平衡。自体输血有效减少或避免免疫抑制,提高恶性肿瘤患者的术后生存期,降低肿瘤的复发率。同时还可以降低血液粘稠度,改善了微循环灌注,有利于前臂皮瓣的血供和存活。ANH对舌癌手术预后有良好作用,对节约用血、减少或避免血源性传染病有重要价值,特别是对RH阴性这种特殊血型的患者而言,ANH自体输血可以缩短手术准备时间。

Objective：To evaluate the effects of acute normovolemic hemodilution（ANH） on the treatment of patients with tongue cancer. Methods：Two patients with tongue cancer were selected to receive autologous blood transfusion. Hydroxyethyl starch（HES） was used as the hemodilution fluid. Anesthesia was induced with midazolam, fentanyl and propofol. The patients were mechanically ventilated and PaO2 and PaCO2 were maintained within normal range. After induction blood was withdrawn from radialis arteria and collected in standard blood bags containing anticoagulant and at the same time replaced with equal volume HES. Two patients were received extensive resection of mass of the tongue and radical neck dissection and reconstruction with chinese flap. Autologous blood transfusion was carried on at the end of the operation. Blood routine , prothrombin time （PT）, activated partial thromboplastin time（APTT） were checked on the 1st and 5th postoperative day. Results： Two patients were recovered rapidly and the flaps were survived well. Comparison of blood roution, PT and APTT of preoperation with 1st and 5th postoperative day also showed that the recovery were rapidly with less complication. Conclusion： ANH can reduce or avoid the complication of homologous blood transfusion on treatment of patients with tongue cancer.