急性超容性血液稀释对腰硬联合麻醉下老年病人内环境和凝血功能的影响

The effect of hypervolemic hemodilution on blood and coagulation related parameters in elderly patients with combined spinal-epidural anesthesia

目的探讨术前急性超容血液稀释对腰硬联合麻醉下全髋置换手术老年病人内环境和凝血功能的影响。方法将30例全髋置换手术病人随机分为两组,稀释组(n=l5)和对照组(n=l5)。测定稀释组稀释前(T0)、稀释后(T1)、稀释后30min(T2)和术毕(T3)4个时间点;对照组麻醉后(T1)、麻醉后30min(T2)和术毕(T3)3个时间点动脉血K+、Na+、Ca2+、Cl-的浓度及部分凝血活酶时间、凝血酶原时间和血气分析的变化。结果pH值:稀释组T1-3较T0降低,而且低于对照组,T1、T2和T3之间无明显改变。两组K+、Na+、Ca2+、Cl-、剩余碱(BE)、部分疑血活酶时间(APTT)和疑血酶原时间(PT)的变化比较差异无统计学意义。结论术前急性超容性血液稀释对腰硬联合麻醉下全髋置换手术老年病人的内环境和凝血功能无明显影响。

Objective To investigate the effect of preoperative acute hypervolemic hemodilution on blood and coagulation related parame- ters in elderly patients with combined spinal - epidural anesthesia for total hip replacement surgery. Methods Thirty cases of total hip replacement surgery patients were randomly divided into preoperative acute hypervolemie hemodilution group and control group with 15 cases in each group. Ar- terial blood K ＋ , Na ＋ , Ca2 ＋ and Cl - levels, activated partial thromboplastin time （ APTY）, prothrombin time （PT） and blood gas were analyzed at the times of before dilution （ T0 ）, immediately after dilution （T1 ）, 30 minutes after dilution （ T2 ） and the time of operation completion （ T3 ） in dilution group and at the times immediately after anesthesia （T1 ）, 30 minutes after anesthesia （T2 ） and the time of operation completion （ T3 ） in control group. Results The pH at T1 ,T2 and T3 in dilution group was lower than those at To （ P 〈0.01 ） and those at T1, T2 and T3 in control group （ P 〈0.05）, while no significant change was found among T1 ,T2 and T3（ P 〉 0.05）. There were no significant differences in the level of K ＋ , Na＋ , Ca2＋ and Cl - concentrations, base excess, APTT and PT between the two groups （ P 〉 0.05 ）. Conclusion Preoperative acute hypervolemic hemodilution does not show obvious effect on blood and coagulation related parameters in elderly patients with combined spinal - epi- dural anesthesia.