ANH联合控制性降压减少异位妊娠手术异体输血的临床研究

Influence of acute normvolemic hemodilution combined with controlled hypotension on allogeneic blood transfusion in surgical patients with ectopic pregnancy

目的:探讨急性等容性血液稀释(ANH)联合控制性降压(CH)对异位妊娠手术患者异体输血及安全性的影响。方法:选择2015-01-2016-08妇产科异位妊娠破裂伴出血性休克患者72例,按照数字列表法将患者随机分为ANH+CH组和ANH组,每组36例。ANH组行术中ANH,ANH+CH组在ANH基础上行CH。观察2组ANH前、后,手术开始后30min及术毕时的平均动脉压(MAP)、中心静脉压(CVP)、心率(HR)等。记录2组术中失血量、异体输血量及尿量。结果:与ANH组比较,ANH+CH组MAP在ANH后即刻、ANH后30min及术毕时降低(P<0.05),而HR在ANH后即刻、ANH后30min升高(P<0.05),但均在正常范围内。2组不同时间节点CVP比较差异无统计学意义(P>0.05)。ANH+CH组术中出血量和异体输血量均明显少于ANH组,差异有统计学意义(P<0.05)。结论:ANH与CH联合应用于异位妊娠手术,可维持患者血流动力学的稳定,减少异体输血,具有更有效的血液保护效应和安全性。

Objective：To explore the influence of acute normvolemic hemodilution （ANH） combined with controlled hypotension （CH） on allogeneic blood transfusion in surgery patients with ectopic pregnancy.Method：A total of 72 cases of surgical patients with ectopic pregnancy in the Fourth People＇s Hospital of Langfang City between January 2015 and August 2016 were enrolled in this study,and assigned to ANH＋CH group and ANH group,36 cases in each group.The patients in ANH group were implemented ANH,and the patients in ANH＋CH group were implemented CH on the basis of ANH.Mean arterial pressure（MAP）,central venous pressure（CVP）,heart rate （HR） before and after ANH,30 min after operation,end of the surgery were observed and recorded in two groups.Intraoperative blood loss,allogeneic blood transfusion volume,urine output were recorded in two groups.Result：Compared with AHH group,MAP reduced immediately after ANH,30 min after ANH,end of the surgery （P〈0.05） and HR elevated immediately after ANH,30 min after ANH （P〈0.05） in ANH＋CH group,but in the normal range.CVP at different time nodes were no significant difference （P〈0.05） in two groups.Intraoperative blood loss and allogeneic blood transfusion volume in ANH＋CH group were significantly less than those in AHH group,the differences were statistically significant （P〈0.05）.Conclusion：ANH logeneic blood transfusion in surgical patients with ectopic pregnancy,which have more effective blood conservation effect and safety.