骨科围手术期急性等容稀释性自体输血安全性研究

The Study of the Security of Acute Normovolemic Hemodilution Autologous Transfusion in Orthopedic Perioperation

目的探讨急性等容稀释性（acute normovolemic hemodilution,ANH）自体输血在骨科围手术期的安全性。方法对本院骨科2007年7月～2013年8月住院的40例患者在麻醉后临手术前采集自体血,同时补充晶体液和（或）胶体液,采集过程中监测患者各项生命体征,手术近结束后立即将自体血回输。对照组为同期住院行择期骨科手术的患者34例,对照组未自体或异体输血。测定两组患者入院时及手术后2d的血常规并进行对比。结果两组患者手术前血常规各项指标的差异无统计学意义,ANH自体输血患者手术前和自体血回输后红细胞（RBC）、血红蛋白（HB）、红细胞压积（HCT）、血小板（PLT）的差异无统计学意义；对照组患者手术后RBC、HB、HCT较手术前显著下降（P〈0.05）。40例ANH自体输血患者均未发生采血及回输血不良反应,各项生命体征正常。结论 ANH自体输血能解决骨科血源稀缺难题,在应对骨科手术患者术中出血时发挥重要作用,对患者无不良影响,是一种安全、有效的输血方式。

Objective To explore the security of acute normovolemic hemodilution autologous transfusion in orthopedic perioperation.Methods Blood from 40cases of patients with orthopedics diseases from July 2007to August 2013in Taihe Hospital were collected before operation.At the same time,the patients were given colloidal fluid and/or crystal fluid.In the process of blood collection,the vital signs was monitored.After operations,the venous blood samples were immediately transfused respectively.As a control,34cases of patients with orthopedics diseases did not have autologous transfusion or allogeneic transfusion.The bloods test results of the two groups were compared before and after operations.Results There was no statistical difference in these two groups before operations.And no statistical difference was noted in RBC,HB,HCT,PLT of the ANH autologous transfusion patients before the operations and after the blood transfusion.While the levels of RBC,HB,HCT were decreased in non-ANH autologous transfusion patients after the operations.In addition,no adverse effects were seen in the 40ANH autologous transfusion patients during blood collection or transfusion.Conclusions ANH autologous transfusion can solve the problem of blood shortage and plays an important role during intraoperative bleeding without adverse effects.It is a safe and an effective way of blood transfusion.