急性高容性血液稀释联合自体血回收回输技术在全髋关节置换手术中的应用及对患者的影响

Clinical application of acute hypervolaemic haemodilution combined with autologous blood transfusion in total hip joint replacement

目的评价急性高容性血液稀释和自体血回收回输技术联合应用对全髋关节置换手术的血液保护效果及其安全性。方法 2010年9月至2012年3月在本组实施全髋关节置换手术、预计出血量>600ml的120例患者随机分为四组,每组30例:对照组、急性高容性血液稀释组、自体血回输组、急性高容性血液稀释组+自体血回收回输组。术中、术后对血流动力学指标、凝血功能进行检测,记录术中失血量、输血量,麻醉时间和手术时间,以及评价并发症。结果采用自体回输血技术的患者中约50%患者不用再输异体血,其中自体血回输组未输异体血的比例46.67%、急性高容性血液稀释组+自体血回收回输组未输异体血比例为60%,而对照组中仅10%的患者不需输入异体血,单纯AHH组为1/3患者未输异体血。与对照组相比,所有采用血液保护措施的患者异体输血量比对照组约少240ml,自体血回输技术的再回收率约为40%;术中、术后各组血流动力学指标和凝血功能指标无明显差异,均保持维持稳定;各种组均未发现与应用血液保护技术有关的并发症。结论联合应用急性高容性血液稀释和自体血回收回输技术,可以明显减少失血量、降低异体输血,对患者影响小,并发症低,对全髋关节置换手术来说是一种安全有效的血液保护技术,值得推广应用。

Objective To evaluate the effect and safety of acute hypervolaemic haemodilution （AHH） combined with autologous blood transfusion in total hip joint replacement. Methods From September 2010 to March 2012, 120 cases of total hip replacement which were carried out in our hospital and the estimated amount of bleeding was over 600 ml, were randomly divided into four groups （ n = 30） ： control group, AHH group, autologous blood transfusion group, and AHH ＋ autologous blood transfusion group. Intraoperative and postoperative hemodynamics, coagulation function, blood loss volume, blood transfusion volume, duration of anesthesia and operation time were measured; complications were also evaluated. Results There was no significant difference in blood loss and operative time among four groups, and the average blood loss was 600 ml or so. Approximately 50% of the patients who had autologous blood transfusion did not require allogeneic blood transfusion. 60% patients of AHH ＋ sutologous group did not need allogeneic blood transfusion, while in control group only 10% patients did not have allogeneic blood transfusion. Compared with the control group, the allogeneic blood transfusion volume of all the patients with blood conservation measures was 240 ml less; the reinfusion rate of autologous blood transfusion was about 40%. The hemodynamic parameters of each group remained stable,and coagulation parameters among the groups were not significantly different. Conclusions Acute hypervolaemic haemodilution combined with autologous blood transfusion technology can significantly reduce blood loss and reduce allogeneic blood transfusion with a low rate of complications. It is a safe and effective blood conservation technique, which should be widely applied.