急性非等容血液稀释治疗COPD合并红细胞增多患者的可行性

Feasibility research of acute non-isovolemic hemodilution for the treatment of COPD with polycythemia

目的探索急性非等容血液稀释(ANIH)治疗慢性阻塞性肺疾病急性加重期(AECOPD)合并红细胞增多患者的安全性和可行性。方法在ICU选择血红蛋白(Hb)≥150 g/L的AECOPD患者20例,在常规治疗基础上,采集静脉血10 ml/kg弃掉,然后补充1.5倍采血量的羟乙基淀粉氯化钠注射液。观察稀释后循环、血常规、乳酸(LAC)、血气、凝血相、电解质、血浆蛋白、渗透压、B型利钠肽(BNP)各项指标的变化及并发症情况,统计采血量、胶体输入量、呼吸机带机时间、住ICU时间和ICU转出率。结果所采血样均呈黑褐色浓稠状,采血量(586±110)ml;胶体输入量(839±157)ml;呼吸机带机时间(82.8±26.4)h。患者稀释后与稀释前比较:(1)循环功能稳定,Hb、红细胞压积(Hct)和LAC明显下降(P均<0.05);(2)动脉血氧分压(PaO_2)上升,碱剩余(BE)和BNP降低(P均<0.05);(3)凝血相、电解质和渗透压无明显变化,血浆总蛋白和白蛋白下降(P均<0.05)。住ICU时间(5.3±2.7)d,所有病例均顺利转出ICU,未见不良反应。结论 ANIH可作为AECOPD重要的治疗新手段,操作简单、安全、可行,有一定临床应用价值。

Objective To explore the safety and feasibility of acute non-isovolemic hemodilution（ANIH） for the treatment of acute exacerbation of chronic obstructive pulmonary disease（AECOPD） combined with polycythemia. Method Twenty AECOPD patients with hemoglobin（Hb） more than or equal to 150 g/L admitted in ICU were selected. Venous blood of 10 ml/kg was collected and discarded,and then hydroxyethyl starch normal saline injection of 1. 5 times of amount of blood taken was added. Circulatory function,blood routine,lactic acid（LAC）,blood gas indexes,coagulation indexes,electrolytes,plasma protein,osmotic pressure,B-type natriuretic peptide（BNP） and complications were observed,and amount of blood taken,amount of colloidal input,utilization time of respirators,ICU stay,transferred out rate from ICU were counted. Results Collected blood samples were all dark brown and thick. Amount of blood taken was（586 ± 110） ml.Amount of colloidal input was（839 ± 157） ml. Utilization time of respirators was（82. 8 ± 26. 4） hours. Compared with before the treatment of ANIH,the clinical related indexes after treatment of ANIH improved：（1） Circulatory function was stabilized,while Hb,hematocrit（Hct） and LAC decreased significantly（all P 〈0. 05）.（2） Arterial oxygen partial pressure（PaO2） rose,but base excess（BE） and BNP decreased significantly（all P 〈0. 05）.（3） Coagulation indexes,electrolytes,osmotic pressure unchanged,while plasma total protein and albumin decreased significantly（all P 〈0. 05）. ICU stay was（5. 3 ± 2. 7） days. All patients were successfully transferred out from ICU,no adverse reaction occurred.Conclusion ANIH can be served as an important and new means for the treatment of AECOPD,and has the advantages of ease to operation,safe and feasible,and thus it has a certain clinical application value.