急性高容量血液稀释联合控制性降压和自体血回收在全髋关节置换术中的应用

Applicacation of acute hypervolemic hemodilution combined with hypotension controlled and autogolous (allogeneic) blood transfusion on patients undergoing total hip replacement

目的观察急性高容量血液稀释(AHH)联合控制性降压(CH)和自体血回收回输技术应用于全髋关节置换术的临床效果与安全性。方法60例全髋关节置换术,用抽签法随机均分成观察组(A组)和对照组(C组),A组全麻诱导后30 min内输入6%羟乙基淀粉130/0.4 15 ml/kg。手术开始时用硝酸甘油行CH,维持MAP(65±5)mmHg,并应用自体血液回收仪回收回输术野出血。C组除未行CH外,余操作均同A组,两组术中连续监测HR、MAP、中心静脉压(CVP);记录出血量、异体血输入量及手术时间,并分别于AHH前、AHH后、术毕测定Hb、血细胞比容(Hct)及凝血酶原时间(PT)、活化的部分凝血酶原时间(APTT)和纤维蛋白原(FG)。结果A组失血量(515±123)ml和回输洗涤红细胞量(275±53)ml均显著低于C组(950±183)ml和(425±97)ml(P<0.01);两组Hct、Hb在AHH后和术毕较AHH前降低(P<0.01),两组PT、APTT在AHH后和术毕均长于AHH前(P<0.01),而FG低于AHH前(P<0.01),但均在正常范围。A组未输入异体血,C组3例输入少浆血2 U,5例输入新鲜冰冻血浆200 ml。两组均无肺水肿、心衰及创面异常出血等并发症。结论AHH联合CH可安全用于全髋关节置换术,并明显减少术中出血量,术中配合自体血回收回输技术可减少甚至避免异体输血。

Objective To evaluate the clinic effects of acute hypervolemic hemodilution（AHH） combined with induced hypotension （CH） and autogolous （allogeneic） blood transfusion on patients undergoing total hip replacement. Methods Sixty patients undergoing total hip replacement randomly divided into two groups with 30 patients each. The patients in experimental group （n = 30） receive 6% HES 15 ml/kg in 30 minutes after anesthesia, MAP were maintained in a range of （65± 5） mm Hg by nitroglycerin. Control group （n= 30）were managed in the same way, but induced artery blood pressure only in by nitroglycerin. The HR, MAP,CVP, blood loss, blood transfusion and the time of operation were recored. The Hb,Hct,PT,APTT and FG were measured at before of AHH, after of AHH and the end of operation. Results The blood loss in experimental group were significantly lower compared with its in control group （P〈0.01）. The Hct and Hb in experimental group on after AHH and the end of operation were lower compared with those before AHH. The PT, APTT and FG were increased in experimental group as compared to that before AHH. No lung edema,heart failure and unconventionality bleeding occur in two groups. Conclusion AHH combined CH were safety and decrease blood loss in the total hip replacement, Autogolous blood transfusion can reduce the capacity of blood transfusion.