急性等容性血液稀释在脑梗死病史患者脊柱手术中的可行性

The Feasibility of Acute Normovolemic Hemodilution in Spinal Surgery in Patients with a History of Cerebral Infarction

目的观察急性等容性血液稀释(acute normovolemic hemodilution,ANH)在有脑梗死病史患者脊柱肿瘤术中应用的可行性。方法选取脑梗死病史患者40例,按照随机数字表法分为观察组和对照组,各20例。观察组经桡动脉采血,经右颈内静脉补充等容量晶体胶体。观察组红细胞比容(Hct)<25%时回输自体血,自体血输完当Hct<25%或血红蛋白(Hb)<70 g·L-1时行异体输血。对照组在术中出血>20%血容量或Hb<70 g·L-1时行异体输血。记录诱导后(T 1)、观察组自体输血前/对照组异体输血前(T 2)、术毕(T 3)心率、平均动脉压(MAP)、血脂四项[总胆固醇(TC)、三酰甘油(TG)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)]、凝血功能[凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、血小板(PLT)]和血糖(GLU)。记录2组患者术中异体血输注量和术后7 d新发脑梗死情况。结果观察组2例输注异体血,共输入异体红细胞8 U,血浆800 mL,对照组10例输注异体血,共输异体红细胞30 U,血浆3000 mL,2组比较差异有统计学意义(P<0.05)。2组患者术后7 d均无新发脑梗死。与T 1比较,观察组与对照组TC[(2.8±0.6)vs(4.0±0.9)]mmol·L-1、TG[(0.6±0.1)vs(0.9±0.3)]mmol·L-1、HDL-C[(0.6±0.2)vs(0.8±0.2)]mmol·L-1、LDL-C[(2.0±0.5)vs(2.8±0.6)]mmol·L-1 T 2明显降低,差异有统计学意义(P<0.05);与对照组比较,观察组TC、TG在T 2~T 3明显降低,HDL-C在T 3明显降低,LDL-C在T 2明显降低,差异均有统计学意义(P<0.05)。与T 1[(5.0±1.4)vs(4.8±1.2)]mmol·L-1比较,2组患者血糖在T 2[(8.0±2.5)vs(7.5±3.1)]mmol·L-1、T 3[(9.0±2.8)vs(9.5±2.8)]mmol·L-1时明显升高,差异有统计学意义(P<0.05)。结论ANH用于有脑梗死病史患者脊柱肿瘤手术中,能够减少异体血使用,不影响凝血功能,围术期未诱发新发脑梗死。

Objective To evaluate the feasibility of acute normovolemic hemodilution(ANH)in spinal tumor surgery in patients with a history of cerebral infarction.Methods 40 patients with history of cerebral infarction were divided into the observation group(n=20)and the control group(n=20)according to random number table method.In the observation group,blood was collected through the radial artery and equal volume lens colloid was supplemented through the right internal jugular vein.Autologous blood was transfused back when hematocrit(HCT)<25%in the observation group,and allogeneic blood transfusion was performed when Hct<25%or hemoglobin(Hb)<70 g·L-1.the control group received allogeneic blood transfusion when intraoperative hemorrhage>20%blood volume or Hb<70 g·L-1.The heart rate,mean arterial pressure,4 blood lipids[total cholesterol(TC),triglycerides(TG),high Density lipoprotein cholesterol(HDL-C),low density lipoprotein cholesterol(LDL-C)],coagulation function[prothrombin time(PT),activated partial thromboplastin time(APTT),platelets(PLT)]and blood glucose after induction(T 1),before autotransfusion in the observation group/before allogeneic blood transfusion in the control group(T 2),after operation(T 3)were recorded.The amount of allogeneic blood transfusion during the operation and the new cerebral infarction 7 days after the operation were recorded.Results In the observation group,2 patients were transfused with allogeneic blood,8 U of red blood cells and 800 mL of plasma were transfused.In the control group,10 patients were transfused with allogeneic blood,30 U of red blood cells and 3000 mL of plasma were transfused.The difference between the two groups was statistically significant(P<0.05).There was no new cerebral infarction in both groups 7 days after operation.Compared with T 1,TC[(2.8±0.6)vs(4.0±0.9)]mmol·L-1,TG[(0.6±0.1)vs(0.9±0.3)]mmol·L-1,HDL-C[(0.6±0.2)vs(0.8±0.2)]mmol·L-1,LDL-C[(2.0±0.5)vs(2.8±0.6)]mmol·L-1 of the observation group and the control group at T 2 were signifi-cantly reduced,the differences were statistically significant(P<0.05);compared with the control group,the TC,TG at T 2~T 3 was significantly reduced of the observation group,HDL-C was significantly reduced at T 3,and LDL-C was significantly reduced at T 2,the differences were statistically significant(P<0.05).Compared with T 1[(5.0±1.4)vs(4.8±1.2)]mmol·L-1,the blood glucose of patients in both groups was significantly increased at T 2[(8.0±2.5)vs(7.5±3.1)]mmol·L-1,T 3[(9.0±2.8)vs(9.5±2.8)]mmol·L-1,and the difference was statistically significant(P<0.05).Conclusion Using ANH for spinal tumor surgery in patients with a history of cerebral infarction can reduce allogeneic blood transfusion without affecting the coagulation function.No new cerebral infarction was induced during the perioperative period.