围术期动态监测Hb/Hct对血液保护的临床研究

Clinical study on blood protection of intraoperative dynamic Hb/Hct monitoring

目的探讨围术期使用微量离心动态测定仪动态监测Hb/Hct对血液保护的实用性、可靠性、准确性、快速性。方法术中用STS-6100型微量离心动态测定仪快速测出Hb/Hct的值;并根据此值采取血液保护的各种措施进行节约用血,开展急性等容血液稀释,复合应用抗纤容酶制剂,预扩容复合抑肽酶使用,术前输注平衡液、胶体(明胶、羟乙基淀粉)扩容,术中控制性降压,血液回收等方法。结果将2006年至2009年4年施行各类大型手术16990例与2005年手术输血量进行对比研究,观察术中动态监测Hb/Hct的值,采取各种血液保护措施后输血量进行分析总结,2006年至2009年输血量与2005年的比较,每年手术以10%以上增长,而输血量不断地减少,结果显示差异有统计学意义(P<0.01)。其中对髋关节手术输血量进行观察,2006年至2009年髋关节输血量与2005年的比较,髋关节大型手术不输血例数逐年增多,结果显示差异有统计学意义(P<0.05)。从2006年至2009年无合并症的青壮年择期手术一般Hb控制在60～70g/L围术期间不输血与Hb在100g/L以上者相比,伤口愈合良好、无感染,无其他并发症,住院时间无延长,前者与后者比较差异无统计学意义。结论围术期使用微量离心动态测定仪动态监测Hb/Hct对血液保护具有实用性、可靠性、准确性及快速性,能够指导围术期需不需要输血、输什么血、输多少血、输什么成分血,避免了不必要的输血给患者带来的危害。

Objective To explore the practicability, reliability, accuracy and rapidity of blood protection of dynamic Hb/Hct monitoring using a micro-centrifuge detector. Methods Hb/Hct value was rapidly measured using STS-6100 micro-centrifuge detector,and on the basis of the value various blood protection measures were taken to save blood use, acute normovolemic hemodilution, composite application of antiplasmin agents, pre-expansion of composite aprotinin, preoperative balance solution transfusion, colloid（gelatin, hydroxyethyl starch）expansion, intraoperative controlled hypotension, and blood salvage were performed. Results Blood transfusion volume of 16990 major operations from 2006 to 2009 was compared with that in 2005. Intraoperative dynamic Hb/Hct monitoring was performed, and transfusion volumes after various blood protection measures were analyzed. It was found that the number of operations grew more than 10% every year, While blood transfusion volume kept decreasing, and the results showed significant difference（P〈0.01）. Transfusion volume of hip joint operation in 2006-2009 was compared with that in 2005, it was found that the number of major hip joint operations without any blood transfusion was growing every year, and the differences was significant（P〈0.05）. Conclusion Intraoperative micro-centrifuge dynamic Hb/Hct detector has blood protection effect, and is practical, reliable, accurate and rapid. It can give guidance on whether, what, how much, what components to transfuse during perioperative period, and help to prevent hazards brought by unnecessary transfusion.