应用晶体或胶体进行高容量血液稀释对血液流变特性的影响

Hemorheology property effects of hypervolemic hemodilution using artificial colloid solution or cyrstalloid solution

目的 急性高容量血液稀释 (acutehypervolemichemodilutionAHH)是一项减少围术期异体血输入量的新技术。观察和比较骨科手术病人应用晶体溶液及胶体溶液进行AHH后血液流变特性的变化 ,为围术期AHH方案的制定、为临床合理应用血浆代用品提供实验依据。方法 骨科择期手术患者 6 0例 ,随机分为三组 :6 %羟乙基淀粉组 (H组 ,n =2 0 ) ,林格氏液组 (R组 ,n =2 0 ) ,4 %琥珀酰明胶组 (G组 ,n=2 0 ) ,于手术开始前 ,按 2 0ml/kg的容量以 0 5～ 0 75ml·kg-1·min-1的速度分别输注以扩充血容量 ,达到高容量血液稀释 ,维持血循环指标在正常范围 ,检测稀释前、稀释后 30min、稀释后 2h ,全血粘度、血浆粘度、Hct、红细胞聚集指数、红细胞变形指数。结果 (1)AHH后患者循环功能稳定 ,围术期异体血输入量胶体液组明显少于晶体液组 ;(2 )AHH后三组患者全血粘度、Hct明显降低 ,红细胞聚集指数降低 ,红细胞变形指数H组升高。结论 术前AHH可以有效地维持术中血循环功能稳定 ,优化血液流变状态 ,利于微循环灌注 ,提高患者对失血的耐受性。应用胶体型血浆代用品进行AHH可以改善血容量相对不足状态 ,增加心脏前负荷 。

Objective In the present study the changes of hemorheology property were observed and compared in patients who accepted selective orthopedic operation after acute hypervolemic hemodilution(AHH) using colloid solution and crystalloid solution respectively to provide clinical basis for the scheme and clinical application of AHH with artificial plasma substitutes.Methods 60 patients of selective orthopedic operation were randomly divided into 3 groups group H(HydroxyEethyl Starch 200/0 5 HES, n=20),group G(Gelofusine GF, n=20) and group R(Ringer's solution,n=20).The patients were respectively treated with 6%HES,GF and Ringer's solution for AHH at the rate of 0 5～0 75 ml.kg -1 .min -1 with the volume of 20ml.kg -1 before anesthesia and operation.The amount of hemorrhage during operation and the amount of blood transfusion in perioperative period were recorded and the functions of circulation were monitored, and the viscosity of whole blood, plasma viscosity, Hct, the index of RBC aggregation and the index of RBC deformation were measured by hemorheology analyzer was assayed with enzyme linked with immune scanner before AHH and 30 minutes, 2 hours after AHH respectively.Results (1)The functions of circulation in all patients were stable, but the amount of blood transfusion in the colloid groups(group H and group G) was less than in the crystalloid group(group R);(2)The viscosity of whole blood, Hct and the index of RBC aggregation were significantly decreased in all groups, but the index of RBC deformation was obviously increased in group H.Conclusion (1)AHH with artificial colloid plasma substitutes in perioperative period might effectively maintain the stability of circulation, enhance the tolerance of patients to the loss of blood, improve the hemorheological condition and ameliorate the perfusion of microcirculation;(2)Artificial colloid plasma substitutes is the better choice for AHH.