急性等容血液稀释联合术中血液回收对强直性脊柱炎后凸畸形截骨矫正术患者血液保护作用

Role of acute normovolemic hemodilution combined with intraoperative blood salvage on blood protection in patients with ankylosing spondylitis kyphosis undergoing osteotomy

目的:探究急性等容血液稀释(ANH)联合术中血液回收(IBS)对强直性脊柱炎后凸畸形截骨矫正术患者血液的保护作用。方法:选取87例强直性脊柱炎后凸畸形截骨矫正术患者为研究对象,按照干预方式不同分为ANH组、IBS组和ANH联合IBS组,每组各29例。比较各组患者在麻醉诱导10 min后(T0)、放血10 min后(T1)、自体血回输前(T2)、回输血结束后30 min(T3)围术期血流动力学、凝血指标、肾功能指标,记录术中血液保护情况。结果:T1时刻,ANH组和ANH联合IBS组MAP值相较于T0均下降(P<0.05),且两组MAP值均低于IBS组(P<0.05);T2时刻,IBS组MAP值较T0下降(P<0.05),ANH联合IBS组MAP高于IBS组(P<0.05),三组CVP值均低于T0(P<0.05);在T2和T3时,各组患者PT和APTT值较T0时刻均上升(P<0.05);在T3时,ANH组和ANH联合IBS组PT和APTT值均低于IBS组(P<0.05),但ANH组和ANH联合IBS组间无统计学差异(P>0.05);ANH联合IBS组异体红细胞输注量低于ANH组和IBS组(P<0.05)。结论:ANH联合IBS应用于强直性脊柱炎后凸畸形截骨矫正术中,可以有效减少异体输血需求,对血流动力学、凝血功能和肾功能影响较小。

Objective:To analyze the role of acute normovolemic hemodilution(ANH)combined with intraoperative blood salvage(IBS)on blood protection in patients with ankylosing spondylitis kyphosis undergoing osteotomy.Methods:87 patients with ankylosing spondylitis kyphosis were selected as the research subjects,and divided into ANH group,IBS group and ANH with IBS group according to different intervention methods,with 29 cases in each group.The perioperative hemodynamic,coagulation,and renal function indicators between three groups of patients at 10 minutes after anesthesia induction(T0),10 minutes after bloodletting(T1),before autologous blood transfusion(T2),and 30 minutes after transfusion(T3)were compared,and the intraoperative blood protection status was recorded.Results:At T1,the MAP value in ANH group and ANH with IBS group was decreased compared with that at T0(P<0.05),and the MAP value in above two groups was lower than that in IBS group(P<0.05).At T2,the MAP value in IBS group was lower than that at T0(P<0.05),and the MAP in ANH with IBS group was higher than that in IBS group(P<0.05).At T2,the CVP in the three groups was lower than that at T0(P<0.05).At T2 and T3,the PT and APTT in the three groups were risen than those at T0(P<0.05).At T3,the PT and APTT were lower in ANH group and ANH with IBS group than those in IBS group(P<0.05),but there were no significant differences between ANH group and ANH with IBS group(P>0.05).The allogeneic red blood cell transfusion volume in ANH with IBS group was less than that in ANH group and IBS group(P<0.05).Conclusion:ANH combined with IBS during osteotomy for ankylosing spondylitis kyphosis can effectively reduce the demand for allogeneic blood transfusion and has small influence on hemodynamics,coagulation function and renal function.