急性等容血液稀释对组织氧合及凝血功能的影响

Effects of acute normovolemic hemodilution on tissue oxygenation and coagulation

目的 了解急性等容血液稀释自体输血对组织氧合及凝血功能的影响。方法 选择ASAⅠ～Ⅱ级 15例颅脑肿瘤患者 ,手术前经桡动脉采血 8～ 10ml/kg ,同时经颈内静脉输入等容量血定安稀释血液 ,手术结束前自体血回输。血液稀释前后及自体血回输前后各时点监测循环动力学指标、血液成分指标、动静脉血气分析指标和凝血功能指标。结果 采血量 (5 75± 118)ml;急性等容血液稀释后HR、MAP、CVP稳定 ;Hct、Hb明显下降 (P <0 0 5 ) ;CaO2 、CvO2 稍下降(P >0 0 5 ) ,而O2 RE略升高 (P >0 0 5 ) ,SvO2 、pH、BE值均在正常范围 ;Plt、Fib下降 (P <0 0 5 ) ,PT、APTT、TT无明显延长。结论 适度的急性等容血液稀释循环动力学稳定 ;对组织氧合及凝血功能无明显影响 ;用于颅脑肿瘤手术能减少或避免对库血的需求 ,所具有的血液保护作用安全有效 ,临床可以推广应用。

Objective To study effect of acute normovolemic hemodilution (ANHD) on tissue oxygenation and coagulation. Methods Fifteen ASA grade Ⅰ～Ⅱ adult patients with cerebrotumour were choosen. Before operation 8～10 ml of blood was taken per radial artery and isovolemic. Gelofusion was simutanously infused through internal jugular vein for hemodilution. Before operation completion, the autogeneous blood was infused. Hemodynamics, blood components,arterial and venous blood gas analysis and blood coagulability were measured before and after hemodilution. Results Average hemovolume of (575±118) ml was gathered in every patient,after hemodilution HR, MAP, CVP remained stable and Hct, Hb decreased significantly(P<0.05) by comparison to those before hemodilution. CaO 2 ?CvO 2 decreased slightly and O 2ER increased slightly(P>0.05). Plt, Fib decreased (P<0.05) and PT, APTT, TT were normal. Conclusion Hemodynamics remains stable, and tissue oxygenation and coagulation are not affected during mederate ANHD. ANHD can be safely used for the cerebrotumor patients.