骨科手术患者急性高容量血液稀释-止血药-自体血回收联合应用的血液保护效果

Blood-saving efficacy of acute hypervolemic hemodilution.hemostatics.intraoperative blood salvage in patients undergoing orthopedic surgery

目的评价骨科手术患者急性高容量血液稀释（AHH）．止血药-自体血啊收（10BS）的血液保护效果。方法择期骨科手术患者120例，性别不限，年龄18—64岁，ASVⅠ或Ⅱ级，预计术中出血量〉800ml，随机分为4组（n=30）：AHH—IOBS．止血药组、IOBS．止血药组织OBS组和AHH．止血药组OAHH：气管插管后即刻至切皮前即刻，静脉输注6％羟乙基淀粉130／0．4溶液15ml／kg，速率40ml／min；IOBS：切皮前即刻行血液回收，血液洗出后即刻回输；止血药：切皮前10min静脉注射血凝酶2ku，同时肌肉注射1kUo记录术中液体出入量、心率（HR）、平均动脉压（MAP）和中心静脉压（CVP），并采集静脉血样检测下列指标：血红蛋白浓度（Hb）、红细胞压积（Hct）、血小板计数（Pit）、凝血酶原时间（PT）、活化部分凝血酶原时间（APTr）和纤维蛋白原浓度（Fib）。结果与AHH．IOBS．止血药组比较，IOBS．止血药组CVP降低，lib、Hot、Plt和Fib升高，AHH-IOBS组术中出血量增多，AHH2止血药组异体输血量增多和新鲜冰冻血浆使用免除率和异体输血免除率降低（P〈0。05或0．01）。结论骨科手术患者hrIH—IOBS．止血．联合应用的血液保护效应较好，安全性高。

Objective To evaluate the blood-saving efficacy of acute hypervolemic hemodilution （AHH）- hemostatics-intraoperative blood salvage （IOBS） in patients undergoing orthopedic surgery. Methods One hundred and twenty ASA Ⅰ or Ⅱ patients of both sexes, aged 18-64 yr, scheduled for elective orthopedic surgery under general anesthesia with an expected blood loss of 800 ml or more, were randomly divided into 4 groups （ n = 30 each） ： AHH ＋ IOBS ＋ hemostatics group; IOBS ＋ hemostatics group; AHH ＋ IOBS group; AHH - hemostatics group. AHH was induced with 6% hydroxyethyl starch 130/0.4 15 ml/kg infused iv at a rate of 40 ml/min immediately after tracheal intubation until the time of immediately before skin incision. IOBS was performed immediately before skin incision. Intravenous hemocoagulase 2 kU and im hemocoagulase 1 kU were injected 10 min before skin incision. The total volume of fluid intake and output, HR. MAP and CVP were recorded during the operation. Voin blood samples were taken for determination of Hb, Hct, platelet counts （Pit）, prothrombin time （PT）, activated partial thromboplastin time （APTT）, and fibrinogen concentration （Fib）. Results CVP was significantly lower in IOBS ＋ hemostatics group than in AHH - IOBS ＋ hemostatics group （ P 〈 0.05）, while no significant difference in CVP was found between AHH ＋ lOBS and AHH ＋IOBS ＋ hemostatics group and between AHH ＋ hemostatics and AHH ＋ ~OBS ＋ hemostatlcs group （ P 〉 0.05）. The volume of blood loss was significantly higher in AHH ＋ IOBS group, and the allogenic blood transfusion volume was significantly higher, while the percentage of the patients without allogeneic blood transfusion and without FFP transfusion lower in AHH＋hemostaties group than in AHH ＋IOBS＋ hemostatics group （ P 〈 0.05 or 0.01）, but there were no significant differences in the above parameters between IOBS ＋ hemostatics group and AHH ＋IOBS ＋ hemostaties group （ P 〉 0.05）. lib, Her, Pit and Fib were significantly higher in IOBS ＋ bemostaties group than in AHH ＋IOBS ＋ bemostatics group（ P 〈 0.05）, but there were no significant differences in the above parameters between AHH ＋ IOBS and AHH ＋IOBS ＋ hemostafics group and between AHH ＋ hemostatics and AHH ＋IOBS ＋ bemostafics group （P 〉 0.05）. Conclusion The blood-saving efficacy of AHH-bemostafics-IOBS is good in patients undergoing orthopedic surgery and it is a safe technique.