急性高容量血液稀释联合自体血回输对全髋置换术患者血流动力学及凝血功能的影响

Effects of acute hypervolemic hemodilution combined with autologous transfusion salvage on hemodynamics and coagulation function in patients undergoing total hip replacement

目的探讨急性高容量血液稀释(AHH)联合自体血液回收对全髋置换术患者血流动力学和凝血功能的影响。方法 40例择期行全髋关节置换手术患者,ASA分级Ⅱ级,采用随机数字表法分为两组,每组20例。A组用6%羟乙基淀粉AHH联合术中自体血回输;B组单用术中自体血回输。两组均于术前(T1)、血液稀释后(T2)、术毕(T3)、术后24 h(T4)、术后3 d(T5)五个时点监测中心静脉压(CVP)、平均动脉血压(MAP)、心电图和尿量;检测活化部分凝血激酶时间(APTT)、凝血酶原时间(PT)、纤维蛋白原(FIB)、血红蛋白(Hb)、红细胞比容(Hct)及血小板计数(PLT)。结果 A组T2、T3时与T1比较,CVP明显增高(P<0.05),但仍在正常范围;Hb、Hct显著降低(P<0.05),与A组比较,B组T4、T5时Hb、Hct明显降低(P<0.05);A组T2、T3、T4时与T1比较,PT延长(P<0.05),APTT无明显变化,FIB和PLT降低(P<0.05);与B组比较,A组T2、T3、T4时PT延长,T3、T4时FIB和PLT降低(P<0.05),并于3 d后逐渐恢复。结论用6%羟乙基淀粉行AHH,对全髋置换术患者的血流动力学无明显不良影响;但可引起CVP升高。AHH联合术中自体血回输可使PT延长,PLT、FIB稀释性降低,但仍在正常范围,APTT变化不大,不影响凝血功能。

Objective To study the effects of acute hypervolemic hemodilution （AHH） combined with autologous transfusion sal- vage on hemodynamics and coagulation function in patients undergoing total hip replacement. Methods Forty patients due to un- dergo total hip replacement surgery （ aged 30 - 65 years, ASA ]I ） were randomly divided into two groups （ n =- 20/group）. Group A was given AHH with hextend plus autologous transfusion salvage and Group B was given autologous transfusion salvage alone. Such parameters as MAP, CVP, HR, APTT, PT, FIB, Hb, PLT and Hct were recorded before operation （T1 ） , after AHH （T2 ） , after operation （T3 ）, 24-hour after operation （ T4 ） and 3rd after operation （T5 ）. Results In Group A, compared to T1 , CVP was increased significantly and Hb and Hct were decreased significantly at T2 and T3 （P 〈 0.05 ） ; compared to Group A, Hb and Hct were decreased significantly at T4 and Ts in group B （P 〈 0.05 ） ; In group A, PT was higher and FIB and PLT were lower at T2 , T3 and T4 than at T1 （P 〈 0.05 ） ; compared to Group B, PT was higher at T2 , T3 and T4 and FIB and PLT were lower at T3 and T4 in Group A （P 〈 0.05） , which returned to normal after three days. Conclusion AHH combined with autologous transfusion salvage has no adverse effect on hemodynamics, but increases PT and decreases FIB and PLT within normal range, which does not affect coagulation function.