乳腺癌根治术中稀释式自体输血与血液稀释的对比观察

Comparative Observation on Dilute Autotransfusion and Acute Hemodilution on Patients with Breast Cancer during Radical Operation

目的 观察在乳腺癌根治术中采用稀释式自体输血和急性血液稀释对血液生理的影响。方法 2 4例乳腺癌根治术病人ASAⅠ～Ⅱ级 ,随机分为自体输血组 (AT)和血液稀释组 (HD)。全麻下 ,AT组采血 396～ 6 39ml,并输等量 6 %羟乙基淀粉 (HES)注射液 ;HD组先输入HES 5 0 0ml后手术。监测术中失血量、输液量、循环生理指标 ,检验术前 (T1)、血液稀释后输自体血前 (T2 )、及术后 1d(T3)的Hgb、RBC、Hct、Plt、WBC、PT、APTT、TT、FIB。结果 AT组T2 的Hgb、RBC、Hct值明显低于HD组 (P <0 0 5 ) ,而T3明显高于HD组 (P <0 0 5 ) ,AT组PT、APTT、TT、FIB各项在四个时间点均无明显变化 (P > 0 5 ) ,检验值全部在正常范围内。结论 稀释式自体输血能更有效的减少血细胞流失 ,维护血液的生理功能 。

Objective To observe the influence of dilute autotransfusion and acute hemodilution on hematophysiologic function in patients with breast cancer during radical operation. Methods 24 patients with breast cancer, ASA I～II, were randomly divided into two groups: autotransfusion (AT) group and hemodilution (HD) group. 396~639ml blood was collected after general anesthesia and the same amount of 6% HES was infused before operation in AT group; In intravenous HD group, blood loss volume, amount of fluid and cyclic physiologic index were monitored during operation. The Hgb, RBC, Hct, Plt, WBC, PT, APTT, FIB and TT were measured and recorded at following occasions: before operation (T 1), after hemodilution (T 2) or before autotransfusion and 1day after operation (T 3). Results Compared with HD group, Hgb, RBC and Hct decreased significantly at T2 (P<0.05), but increased significantly at T3 (P<0.05) in AT group. PT, APTT, FIB and TT were no difference significantly at T 1, T 2, T 3 and T 4 in AT group. Conclusion Dilute autotransfusion might be better than hemodilution in reducing blood loss, preserving RBC and maintaining the function of blood.