急性高容量血液稀释对老年患者髋部术后血栓形成的影响

Effect of acute hypervolemic hemodilution on deep vein thrombosis of elderly patients performed operation on huckle

目的:评价急性高容量血液稀释(acute hypervolemic hemodilution,AHH)对老年患者髋部术后深静脉血栓(deepvenous thrombosis,DVT)形成的影响。方法:择期行髋部手术的老年患者40例,年龄65～85岁,体重52～83 kg,美国麻醉医师协会(ASA)分级Ⅰ或Ⅱ级,随机分为两组:对照组(C组,n=20)和AHH(H组,n=20)。硬膜外麻醉前,经右颈内静脉H组以15～20 ml/(kg.h)的速率输注6%羟乙基淀粉130/0.4注射液,C组按0.7～0.8 ml/(kg.h)速度输注生理盐水,补液时间均为1 h。分别于入室开放静脉后(T0)、术毕(T2)、术后1 d时(T3)抽取两组肘静脉血样,检测红细胞压积(HCT)、凝血酶原时间(PT)、激活的部分凝血酶原时间(APTT)、纤维蛋白原(FIB)和D-二聚体浓度、全血黏度高切变率、全血黏度低切变率、血浆黏度、红细胞聚集指数(EAI)、红细胞变形指数,另每组于补液1 h后(T1),抽取静脉血2 ml测定HCT。术中记录T0及T1时两组中心静脉压(central venous pressure,CVP)值。用彩色多普勒超声于术前1 d及术后7 d时探测两组患者双下肢深静脉通畅情况,检查是否有下肢DVT形成。结果:T0及T1时两组CVP、HCT均在正常范围内。与T0比较,T2及T3时H组全血黏度高切变率、全血黏度低切变率、血浆黏度及红细胞聚集指数降低,红细胞变形指数升高;C组T2及T3时血浆黏度降低且T3时D-二聚体升高(P<0.05)。与C组比较,H组T2及T3时全血黏度高切变率、全血黏度低切变率及红细胞聚集指数降低,红细胞变形指数升高,T3时H组D-二聚体降低(P<0.05)。术后7 d时,彩色多普勒超声下,C组DVT发生率为55%,H组为15%,H组DVT发生率低于C组(P<0.05)。结论:6%羟乙基淀粉术前AHH能改善髋部手术老年患者血液流变学状态,降低发生深静脉血栓形成的危险。

Objective：To investigate the effect of acute hypervolemic hemodilution on deep vein thrombosis（DVT）of elderly patients performed operation on huckle.Methods：Forty ASA Ⅰ or Ⅱ patients aged 65-85 yr weighing 52-83 kg undergoing operation on huckle were randomly allocated into 2 groups（n = 20 each）：control group（group C）;group AHH（group H）.Fluid infusion was performed with 6% HES at 15～20 ml /（kg.h）or normal saline at 0.7～0.8 ml /（kg.h）for 1 h through right internal jugular vein before epidural anesthesia.Venous blood samples were obtained before AHH（T0）,the end of operation（T2）and the first day of post-operation（T3）for measurement of hematocrit（HCT）,prothrombin time（PT）,activated partial thromboplastin time（APTT）,fibrinogen（FIB）,D dimer,whole blood viscocity at low or high shear rates,plasma viscosity,RBC aggregation and RBC deformation.Another venous blood sample was obtained after AHH（T1）for measurement of hematocrit（HCT）.CVP at T0 and T1 were monitored.Two group of patients were survey the deep veins of lower limb by color Doppler ultrasound at the day preoperative and the seventh day post-operation.Results：CVP were stable in all patients.Low or high shear rates,plasma viscosity and RBC aggregation index was significantly decreased in group H at T1 and T3 than at T0.But RBC deformation index was significantly advanced at T2 and T3 than at T0 in group H.Plasma viscosity was significantly decreased at T2 and T3 than at T0 and DD was advanced at T3 than at T0 and T2 in group C.Low or high shear rates and RBC aggregation index was significantly decreased,but RBC deformation index was significantly advanced at T2 and T3 in group H than in group C.DD was decreased at T3 in group H than in group C.The incidence rate of DVT in group H was lower than in group C in the seventh day afteroperation.Conclusion：AHH with HES preoperative improves intraoperative hypercoagulability and sluggish blood flow and decreases the incidence rate of DVT.