稀释式自体输血对宫颈癌术后血栓形成的影响

Effect of Hemodilutional Autotransfusion on Deep Vein Throm bosis of Radical Total Hysterectomy in Women with Cervical Cancer

目的:评价稀释式自体输血对宫颈癌术后血栓形成的影响。方法:因宫颈癌ⅠB1行宫颈癌根治术的患者80例,随机分成观察组、对照组,每组40例。观察组患者术前采用稀释式自体输血,对照组患者按常规手术。分别于入室开放静脉后(T0)、术毕(T1)、术后24小时(T2)抽取两组肘静脉血样,检测血红蛋白(Hb)、血细胞比容(HCT)、凝血功能指标及血液流变学变化指标。用彩色多普勒超声于术前1天及术后7天探测两组患者双下肢深静脉通畅情况。结果:与T0比较,T1及T2时观察组患者Hb和HCT明显降低,与对照组同一时点比较差异有统计学意义(P<0.05)。与T0比较,T1及T2时观察组全血黏度高切变率、全血黏度低切变率、血浆黏度及红细胞聚集指数降低,红细胞变形指数升高;对照组T1及T2时血浆黏度降低且T2时D-二聚体升高(P<0.05)。与对照组比较,观察组T1及T2时全血黏度高切变率、全血黏度低切变率及红细胞聚集指数降低,红细胞变形指数升高,T2时观察组D-二聚体降低(P<0.05)。术后7天时,彩色多普勒超声下,对照组DVT发生率12.5%,观察组无DVT发生。观察组DVT发生率低于对照组(P<0.05)。结论:稀释式自体输血能改善手术患者血液流变学状态,降低发生深静脉血栓形成的危险。

Objective：To investigate the effect of hemodilutional autotransfusion on deep vein thrombosis of patients with cervical cancer after radical total hysterectomy. Methods：Eighty patients with cervical cancer undergoing radical total hysterectomy were randomly divided into 2 groups（n =40 each） ： hemodilutional autotransfusion （HAT） group and control group. Patients in HAT group obtained HAT before the operation. The other patients were administrated via routine operation. Venous blood samples were collected before HAT（T0）, the end of the operation （T1） and the first day of post-operation （ T2 ） for measurement of hemoglobin （ Hb）, hematocrit （ HCT）, coagulation function and hemorheology. The deep veins of lower limb were tested by color Doppler ultrasound at the day preoperative and the seventh day post-operation. Results：The Hb and HCT decreased after HAT. Low or high shear rates, plasma viscosity, RBC aggregation were significantly decreased in group HAT at T1 and T2 than at TO. RBC deformation was significantly increased at T1 and T2 than at TO in group HAT. Plasma viscosity was significantly less at T1 and T2 than at TO and DD was increased at T2 than at TO and T1 in control group. Low or high shear rates and RBC aggregation index were significantly decreased while RBC deformation was significantly increased at T1 and T2 in group HAT than in the control group. DD was decreased at T2 in group HAT than in the control group. The incidence rate of the DVT in group HAT is lower than in the control group in the seventh day af- ter operation. Conclusions：HAT preoperative can improve intraoperative hypercoagulability and sluggish blood flow and decrease the rate of the DVT.