术中不同血红蛋白浓度对手术安全和预后的影响分析

The analysis on the effects of different hemoglobin concentration during the operation on the safety and prognosis of the operation

目的观察和分析术中不同血红蛋白浓度对手术安全和预后的影响。方法选取行气管插管全身麻醉手术患者150例作为研究对象,根据术中患者的血红蛋白(Hb)浓度分别将其分为A组(100g/L≤Hb<120g/L)、B组(80g/L≤Hb<100g/L)和C组(70g/L≤Hb<80g/L),每组各50例。对三组患者在术前(T0)、手术步骤完成时(T1)、术毕(T2)、术后24h(T3)、出院时(T4)的血常规、静脉血乳酸值、动脉血气等指标进行观察和比较,同时对三组患者的术中总输血量、输血并发症情况、住院时间和预后情况进行观察和比较。结果三组患者的红细胞计数(RBC)、Hb、红细胞比容(Hct)水平的组间差异和组内差异均有显著性(P<0.05);三组患者的血乳酸浓度、pH值、二氧化碳分压(PaCO2)、氧分压(PaO2)的组间差异无显著性(P>0.05)而组内差异有显著性(P<0.05);三组患者的术后切口感染或延迟愈合的发生率及住院天数等指标无显著性差异(P>0.05);A组患者的输血量和发生荨麻疹、发热等输血反应的患者比例均显著高于B组(P<0.05),B组均显著高于C组(P<0.05)。结论术中使患者的Hb浓度维持在较低水平可减少术中输血量、降低输血反应的发生率,且对患者的预后无不良影响,可确保患者的术中安全。

Objective To observe and analyze the effects of different hemoglobin concentration during the operation on the safety and prognosis of the operation.Methods 150 patients treated with general anesthesia operation were selected as the research objects and divided into group A （100 g/L≤Hb＜120 g/L）,group B （80 g/L≤Hb＜100 g/L）and group C （70 g/L≤Hb＜80 g/L） according the hemoglobin （Hb） concentration of the patients.50 were included into each group.The routine blood test indexes,the blood lactate levels,the blood gas indexes of the patients in the three groups before the operation （T0）,at the time when the operation step was completed （T1）,at the end of operation （T2）,at the 24 h after the operation （T3）,at the time of discharge （T4） were observed and compared.At the same time,the total amount of blood transfusion during the operation,the hospitalization time,the complications and the prognosis of the patients in the three groups were observed and compared.Results The differences of the red blood cell （RBC） counts,H b,hematocrit （Hct） levels of the patients between the three groups and within the three groups were significant （P＜0.05） ;The differences of the blood lactate concentration,pH value,the partial pressure of carbon dioxide （PaCO2）,the partial pressure of oxygen （PaO2） of the patients between the three groups were not significant （P＞0.05）,while the there differences within the groups were significant （P＜0.05） ;The differences of the incidences of incision infection,incision healing delay after the operation and the hospitalization days were not significant （P＞0.05） ;The ratios of the blood transfusion reactions such as rash,fever were significantly higher than those of group B （P＜0.05） and the ratios of group B were significantly higher than those of group C （P＜0.05）.Conclusion To maintain Hb concentrations of the patients at a lower level during the operation can reduce the intraoperative blood transfusion amounts,reduce the incidence of transfusion reactions,put no adverse effects on the prognosis of the patients,and ensure the safety of patients during operation.