等容血液稀释治疗急性脑梗塞的疗效及影响因素

Effect of Isovolemic Hemodilution in the Treatment of Acute Cerebral Infarction and its Influencing Factors

采用等容血液稀释疗法对31例急性脑梗塞患者进行随机对照研究。稀释组患者(16例)治疗后5d平均血球压积由45.9％降至35.7％,高切和低切全血粘度均显著下降(P<0.001),对照组患者(15例)无明显变化。在90天随访期内,稀释组患者神经功能改善程度显著大于对照组患者(P<0.01);稀释组无死亡,对照组死亡1例。疗效影响因素分析发现,血液稀释治疗前血糖低于6.11mmol/L,平均动脉压>16.0 kPa,血液稀释度在21％～31％的患者疗效较好。

Isovolemic hemodilution was evaluated in a randomized controlled trial enrolling 31 patients with acute cerebral infarction. Five days after treatment, the mean hematocrit was reduced from 45. 9% to 35. 7% and the whole blood viscosity at both high and low shear rates decreased significantly (P< 0. 001) in the 16 patients in hemodilution group. The above parameters in the 15 patients in control group did not change significantly. The improvement of neurologic deficit indicated by neurologic score increment in hemodilution group was significantly better than that in control group during 90 days' follow-up (P<0. 01). There were no deaths in hemodilution group while one patient died in control group. In analysis of factors affecting the efficacy of hemodilution, the hemodiluted patients with base- line blood glucose level of less than 6. 11 mmol/L, with baseline mean artery blood pressure higher than 16. 0 kPa, and with the reduction of hematocrit by 21. 0% to 31. 0% were found to have better long- term improvement.