急性等容血液稀释用于心血管外科血液保护的效果

Evaluation of the effect of acute normovolemic hemodilution on blood conservation during cardiovascular surgery

目的 比较急性等容血液稀释(ANH)联合术中血液回收与单纯术中血液回收用于心血管外科血液保护的临床效果。方法 将术前血红蛋白Hb≥130g/L的心血管外科成年病人140例随机分成两组:A+C组,ANH联合术中血液回收(ANH量 8～12ml/kg,n=70);C组,术中单纯血液回收(n=70)。分别记录两组病人术前及术后24h血红蛋白(Hb)、血球压积(HCT)、血小板(PLT);回收血量;体外循环(CPB)总转流时间;术后24h引流量;全血用量;血浆用量;悬浮红细胞用量;冷沉淀用量;血小板用量和总住院时间。结果 两组病人一般情况无显著差异,术前各实验室指标无显著差异;A+C组术中血液回收量(581.8±28.2)ml少于C组(785.4±43.8)ml,有显著差异(P<0.001);A+C组术后24hHb(122.2±18.8)g/l高于C组(112.3±15.6)g/l,有显著差异(P<0.01),HCT(35.2±5.5)高于C组(33.2±4.5),亦有显著差异(P<0.05);A+C组全血用量(81.7±23.0)ml少于C组(217.4±35.7)ml,有显著差异(P<0.01)A+C组有15例,C组有6例未输异体血;两组间CPB时间、总住院时间及其它血制品用量无显著差异。结论ANH联合术中血液回收比较术中单纯血液回收用于心血管外科血液保护可减少异体血需要及用量,值得推广。

Objective To evaluate the effect of acute normovolemic hemodilution (ANH) on blood conservation during cardiovascular surgery. Methods One hundred and forty adult patients undergoing elective cardiac surgery under CPB were randomly divided into 2 groups: group A+C in which ANH and intraoperative blood salvage were performed ( n = 70) and group C in which only intraoperative blood salvage was performed (n = 70) . CVP line was placed before anesthesia. In group A+C the amount of blood collected before operation was 8-12 ml-kg-1 (Hb was maintained > 100g/L and Hct >30% after ANH) and blood volume was maintained with crystalloid and colloid (1 : 3) . The preoperatively collected blood and the blood salvaged during operation were infused back to the patient after CPB. The operations were performed under CPB with moderate hypothermia. In patients undergoing atrial or ventricular septal defect tranexamic acid 20 ml-kg-1 was given and in other patients aprotinin 5 000 000 U was given. Hb, Hct and platelet count (PLT) were measured and recorded before operation, after ANH and 24h after operation. The volume of RBC salvaged during operation, CPB time and the volume of chest tube drainage at 24h after operation, the volume of whole blood, plasma, packed RBC, cryoprecipitate and platelet transfused and hospitalization time were also recorded. Results The demographic data were comparable between the two groups. There was no significant difference in CPB time and the total days of hospitalization between the two groups. The Hb at 24h after operation was significantly higher in group A +C [(122.2+18.8)g/L] than that in group C [(112.3+15.6)g/L] (P<0.01). The volume of whole blood transfused in group A+C [(81.7 + 23.0)ml] was significantly less than that in group C [(217.4 + 35.7)ml]. There were fifteen patients in group A+C and six patients in group C who avoided exposure to allogeneic blood products. Conclusion ANH combined with intraoperative RBC salvage can reduce the riskof exposing the patients to allogeneic blood products during cardiac surgery.