急性等容血液稀释及自体输血的临床应用

Clinical application of acute normovolemic hemodilution and autotransfusion

目的 研究急性等容血液稀释 (ANHD)及自体输血临床应用的可行性和应用价值。方法 择期手术 40例 ,ASAⅠ～Ⅱ级 ,于麻醉前行ANHD。监测ANHD前 (HD1)、后 (HD2 )及自体血输入后 (HD3 )患者EKG、MAP、CVP ,Hb、Hct、Plt ,凝血功能和动静脉血气分析、血氧含量、摄氧率(ERO2 )。结果 患者HR、MAP、CVP无明显变化。Hb、Hct、Plt在HD2 、HD3 时点较HD1下降 (P <0 0 1) ,最低值分别为 :(10 8 1± 11 0 ) g/L、(32 3± 3 6 ) %、(115 9± 19 7)×10 9/L。动静脉血氧含量在HD2 、HD3 时点与HD1相比下降(P <0 0 5 ) ,最低值分别为 :(15 4 2 9± 17 31)ml/L、(113 96± 18 91)ml/L。凝血功能、动脉血气分析、ERO2 均在正常范围。结论 适度的ANHD能保持血流动力学稳定 ,维持Hb、Plt及凝血功能的正常作用 ,不导致机体酸碱平衡失调 ,机体的氧供氧耗正常。

Objective To study clinically used practicability and value of acute normovolemic hemodilution (ANHD) and autotransfusion. Methods Forty patients (ASAⅠ-Ⅱ) were selected for the experiments, and given ANHD before anesthesia. All patients were monitored by examination of EKG, MAP, CVP, Hb, Hct, Plt, coagulation function, arterial and venous blood gas analysis, CaO 2 (arterial oxygen content), CvO 2 (venous oxygen content), and ERO 2 (oxygen extraction ratio) before ANHD (HD 1), after ANHD (HD 2), and after autotransfusion. (HD 3). Results The HR, MAP and CVP were not significantly different in the HD 1 ,HD 2 and HD 3. But the Hb, Hct and Plt in HD 2 ,HD 3 more dramatically fell than those in HD 1 (P<0.01) and their minimum values were (108.1±11.0)g/L,(32.3±3.6)% and (115.9±19.7)×10 9/L. The CaO 2 and CvO 2 in HD 2,HD 3 more remarkably dropped than those in HD 1 (P<0.05), and the minimum values were (154.29±17.31)ml/L and (113.96±18.91)ml/L. Coagulation function, arterial blood gas analysis and ERO 2 were in the normal range at all. Conclusion Moderate ANHD can maintain hemodynamic stability, and remain normal values of Hb, Plt, coagulation function and normal oxygen supply and demand, simultaneously, and it can not result in acid-base inbalance in body.