ANH对异位妊娠手术患者炎症反应和异体输血的影响

Evaluation of application of acute normovolemic hemodilution autotransfusion in ectopic pregnancy surgery

目的:评价急性等容血液稀释(ANH)式自体输血在异位妊娠手术中的应用价值。方法:选取96例异位妊娠大出血患者为研究对象,以采用ANH的50例患者为观察组,其余46例患者为对照组。记录观察组血液稀释前后动脉血pH、PaO2、PaCO2、HCO3-、碱剩余(BE)、血乳酸(LAC)等血气指标的变化情况。比较2组患者术前、术后1h、术后24hHb、Hct、PLT、凝血酶原时间(PT)、活化凝血活酶时间(APTT)、国际标准化比值(INR)等血液指标及C-反应蛋白(CRP)、白介素-6(IL-6)水平变化情况。比较2组患者出血量和异体输血量。结果:(1)观察组血液稀释前后pH、PaO2、PaCO2、HCO3-、BE、LAC等血气指标均无明显变化(P>0.05);(2)观察组术后1h的Hb、Hct水平明显低于对照组(P<0.05),但术后24h水平高于对照组(P<0.05)。观察组术后1h PT、APTT、INR明显延长(P<0.05),术后24h恢复正常。(3)与术前比较,2组术后1h和24hCRP及IL-6水平明显升高(P<0.05),但观察组CRP及IL-6水平明显低于对照组(P<0.05);2组出血量比较差异无统计学意义(P>0.05),2组异体血输注例数和异体输血量比较,差异有统计学意义(P<0.05)。结论:ANH对异位妊娠手术患者的血流动力学和凝血功能影响较小,可有效减轻炎症反应和减少异体血用量,具有一定的临床应用价值。

Objective：To assess the application value of acute normovolemic hemodilution （ANH） autotransfu sion in ectopic pregnancy surgery. Method： A total of 96 cases of surgical patients with ectopic pregnancy were en- rolled in this study, and 50 cases of patients using ANH as observation group, and the other 46 patients as control group. The changes of blood gas indexes as pH, PaO2 ,PaCO2, HCO3- , BE and LAC were recorded before andafter hemodilution in observation group. The levels of Hb, Hct, PLT, PT, APTT, INR, CRP and IL-6 were compared at preoperative and postoperative 1 h, 24 h in two groups. The blood loss volume and allogeneic blood transfusion amount were compared in two groups. Result： ①The blood gas indexes as pH, PaO2 .PaCO2. HCOa- , BE and LAC were no significant change （P〉0.05） before and after hemodilution in observation group. ②The lev- els of Hb and Hot at postoperative lh in observation group were significantly lower than those in control group （P d0.05）, but the levels at postoperative 24 h in observation group were significantly higher than those in control group （P〈0.05）. PT, APTT and INR at postoperative 1 h were obviously prolonged in observation group（P〈0.05） and returned to normal at postoperative 24 h. ③Compared with preoperative, the levels of CRP and IL-6 in- creased significantly （P〈0.05） at postoperative 1 h,24 h in two groups, but the levels of CRP and IL-6 in obser- vation group were significantly higher than those in control group （P〈0.05）. The differences of the blood loss volume between the two groups had no statistical significance （P〉0.05）. The differences of the cases and amount of allogeneic blood transfusion between the two groups were statistically significant （P〈0.05）. Conclusion： The influences of ANH on hemodynamics and blood coagulation function in patients with ectopic pregnancy surgery might be lesser, which could effectively reduce the inflammatory response and reduce the dosage of allogeneic blood, and has a certain clinical value.