急性等容血液稀释应用于肝癌切除术114例的节血效应分析

Clinical study on the effect of acute normovolemic hemodilution on blood salvage during hepatic cancer surgery

目的 :探讨中度急性等容血液稀释 (ANH)应用于肝癌患者肝切除术时节约用血的效果。方法 :ASA ～ 级成人原发性肝癌行肝切除术患者 114例 ,术前 Hb(134.4 8± 10 .2 4 ) g/ L,Hct(4 2 .32± 3.5 2 ) % ,全麻后采血行 ANH,静脉注输 6 %中分子羟乙基淀粉 (6 % HES)和乳酸钠林格氏液扩容。用纱布称量法和记录吸引瓶血量估算术中失血量。检测术前、ANH后、回输自体血前、回输自体血后即时及术后第 1天 Hb、Hct。用公式计算节省 RBC量 ( 1～ 2 ) :节省 RBC量 =(术前 Hct×失血量 ) -(ANH后 Hct×失血量 )。结果 :采血后 Hb、Hct分别降至 (84 .3± 2 .37) g/ L 和 (2 6 .4 2± 1.4 6 ) % ,回输自体血前最低 Hb、Hct为76 .4 2 g/ L 和 2 3.6 1± 2 .2 7% ,回输自体血后 Hb、Hct显著回升。术中失血 (112 6± 4 5 8) m l(76 0～ 2 6 0 0 ml)。输入 6 % HES(15 4 5±36 4 ) ml。术中无一例输异体血。平均每例病人减少红细胞丢失 194 .5 ml,相当于全血 4 5 9ml。结论 :中度 ANH用于术中失血 80 0～ 10 0 0 ml以上大手术可减少红细胞的丢失 ,起到节省血液资源的效果。减少 RBC丢失和节血效果与血液稀释度和出血量有关。

Objective:To evaluate the effect of acute noderate normovolemic hemodilution(ANH) on intraoperative blood salvage during hepatic cancer surgery Methods:ANH were used in 114 patients with liver cancer undergoing hepatic carcinetomy.Blood loss volume were caculated after operation.Hb,Hct were meassured before anesthesin,After ANH,before and after autohemotransfusion,and 1 day after operation.The amount of blood salvage was estimated from the following equation:Saving RBC=(V L×Hcto)-(V L×Hct minimal ,where V L=loosing blood volume,Hct 0=patient's initial Hct,Hct minadd =patient's minimal Hct during operation Results:Hb,Hct were decreased from 134 48±10 2g/L,42 32±3 52% to 84 3±2 37g/L,23 6±2 27% after hemodilution.There were significant increasing in Hb,Hct after autohemotransfusion.The amount of loss blood volume was 1126±456ml during operation,at the same time infusing 1545±364ml 6% HES.There was no to homologous blood.The average loss blood volume of a patient was 194 5ml RBCs,459ml whole blood Conclusion:Acute normovolemic hemodilution decrease the RBCs loss and the use of homologous undergoing major surgery which may bleed above 800 to 1000ml.The degree of ANH and bleeding volume are dependents of the effect of decreasing RBCs loss