中度急性等容血液稀释用于肝癌切除术对凝血功能的影响

Effects of preoperative acute normovolemic hemodilution in hepatic carcinectomy on the function of blood coagulation

目的 :观察急性中度等容血液稀释和输入 6 %中分子羟乙基淀粉 (2 0 0 0 5 ,HES)对肝癌切除术患者凝血功能的影响。方法 :ASAⅡ级行肝癌切除术患者 31例 ,年龄 (48± 9)岁。全麻后采血并输入 6 % ,HES行中度等容血液稀释 (ANH)。测定术前、采血 (血液稀释 )后、术中和回输自身血后的血小板计数 (PLT)、凝血酶原时间 (PT)、纤维蛋白原 (FIB)、部分凝血活酶时间(APTT)和凝血酶时间 (TT)的改变。结果 :采血后和术中PLC、FIB显著下降 (P <0 0 1) ,PT、APTT显著延长 (P <0 0 1) ,但仍在生理范围内。回输自身血后上述指标明显恢复 (P <0 0 5或 <0 0 1)。手术野和切口无异常出血。结论 :急性中度血液稀释和输入较大量 6 %HES对PLT和部分凝血因子有一定干扰作用 ,但仍在生理范围 ,对凝血功能无明显影响 。

s Objective:To evaluate the influence of preoperative acute normovolemic hemodilution with 6% HES in hepatic carcinectomy on blood coagulation.Metheods:Thirty one adult patients,ASA grade Ⅱ,undergoing hepatic carcinectomy were selected to receive intravenous infusiion of hydroxyethyl starch(6%HES) after general aneasthesia.Platelet count(PLT),fibrinogen(FIB),Protherombin time(PT),activated partial thromboplastin tim(APTT) and thrombin time(TT) were measured before induction anesthesia,30 min following hemodilution,prior and after the retransfusion of blood compenents.Results:PLC and FIB decreased significantly,and PT,APTT were prolonged markedly after hemodilution and prior to retransfusion of blood (P<0 01 or <0 05),but the values of PLC,FIB,PT,APTT were in normal,There was no changes significantly in TT(P>0 05).Conclusions:Althought PLC,FIB were decreased and PT,APTT were prolonged after acute moderate normovolemic hemodilution and the following intravenaus infusion with 6% HES.The results suggested that they have no influence markedly on the function of coagulation,and can may be safely used.