急性高容量血液稀释对血液流变特性影响的临床研究

A clinical study of the effect of acute hypervolemic hemodilution on hemorheology property

目的 观察急性高容量血液稀释 (AHH)后血液流变学特性的变化 ,为临床合理应用血浆代用品提供研究依据。方法 6 0例骨科手术患者随机分为三组 ,每组 2 0例 ,按 2 0ml/kg的扩容量分别输注 6 %羟乙基淀粉、复方氯化钠和 4 %琥珀酰明胶 ,达到高容量血液稀释。检测稀释前后全血粘度、血浆粘度、Hct、红细胞聚集指数、红细胞变形指数。结果 (1)AHH后循环功能稳定 ,围术期异体血输入量胶体液组明显少于晶体液组。 (2 )AHH后全血粘度、Hct明显降低 ,红细胞聚集指数降低 ,红细胞变形指数 6 %羟乙基淀粉组升高。结论 术前AHH可以有效地维持术中循环功能稳定 ,优化血液流变状态 ,利于微循环灌注 ,提高患者对失血的耐受性 ,减少异体血输入量 ,胶体溶液优于晶体溶液。

Objective To observe and compare the changes of hemorheology property in patients undergoing selective orthopedic operation after acute hypervolemic hemodilution (AHH) using colloid and crystalloid solution.Methods Sixty patients of selective orthopedic operation were randomly divided into 3 groups.The patients were respectively treated with 6% HES,GF or Ringers solution for AHH given in a dose of 20ml/kg before operation.The amount of hemorrhage during operation and the amount of blood transfusion during perioperative period were recorded and the viscosity of whole blood,plasma viscosity,Hct,the index of RBC aggregation and the index of RBC deformation were measured before and after AHH respectively.Results 1.The functions of circulation in all patients were stable,but the amount of blood transfusion in the colloid groups was less than that in the crystalloid group; 2.The viscosity of whole blood,Hct and the index of RBC aggregation were significantly decreased in all groups,but the index of RBC deformation was obviously increased in group H.Conclusions AHH with artificial colloid plasma substitutes in perioperative period might effectively maintain the stability of circulation,enhance the tolerance of patients to the blood loss,reduce the amount of blood transfusion,improve the hemorheological condition and ameliorate the perfusion of microcirculation.