等容血液稀释性自体血回输在肝癌手术中的应用

Normovolemic hemodilution autologous blood transfusion in cancer operation

目的研究等容血液稀释自体输血（ANH）对肝癌手术患者围术期机体内环境和凝血功能的影响,探讨ANH的节血效果和安全性。方法选择肝癌手术患者40例,随机分为2组。等容血液稀释性自体输血组（I组）：于麻醉后手术切皮前经桡动脉放血400-600 ml,同时经静脉输入相当容量的万汶血浆替代品,手术后半阶段将自体血回输。未做血液稀释组（II组）：分别于麻醉诱导前（T1）、ANH后30 min及术始（T2）、输血后（T3）、术毕（T4）和术后24 h（T5）测定pH值、HCO3-、K＋、Na＋、PT、APTT、PLT和血浆蛋白。结果 II组有8例输异体血而I组只有2例,2组在输异体血后pH值和HCO3-下降较未输异体血者明显（P〈0.05）。PT、APTT在各测定点2组变化一致,2组间均无显著性差异（P〉0.05）,I组PLT在T3后回升明显而II组继续下降。I和II 2组血浆蛋白在T2都下降明显（P〈0.05）,但I组在T3后回升。结论等容血液稀释自体输血（ANH）对肝癌手术患者的围术期机体内环境和凝血功能影响较小,节血效果明显,安全有效,更具优越性。

Objective To study the effect of acute normovolemic hemodilution （ ANH） autologous blood transfusion on liv-er cancer patients＆#39;organismic internal environment and coagulation function during peri-operative care,and explore blood con-servation effect and safety of ANH autologous blood transfusion .Methods 40 liver cancer patients were selected and divided into 2 groups randomly .Group I：Operations with ANH autologous blood transfusion .Transradial blood-letting 400～600ml was conducted after anesthesia and before skin incision .The same volume of hydroxyethyl starch was infused through vena ,followed by transfusing the autologous blood back to the patients during the second half of the surgical operation ;Group II： Operations without ANH.pH value,HCO3-,K＋,Na＋,PT,APTT,PLT and plasma protein were tested respectively before induction of an-esthesia（T1）,30 minutes after ANH and at the beginning of surgery（T2）,after autologous blood transfusion（T3）,at the end of surgery（T4） and 24 hours after the surgery（T5）.Results 8 cases in Group II underwent allogenic blood transfuson while only 2 cases in Group I.the pH values and HCO3-of the patients with allogenic transfusion dropped more obviously （P〈0. 05） than the ones without allogenic transfusion in the two groups .PT and APTT changes were the same at each observation point for both of the groups with no significant differences （P〉0.05）.PLT of Group I rebounded obviously after T3 while the PLT of Group II continued to decline.Plasma protein of the two groups both declined significantly after T 2 （P〈0.05）,but the samples＆#39;values of Group I were back up after T 3 while Group II were not .Conclusion ANH autologous blood transfusion makes little difference to on liver cancer patients＆#39;organismic internal environment and coagulation function during peri -oper-taive care.It has more advantages in blood conservation ,safety and effectiveness over allogenic transfusion .