回收式自体输血联合血液稀释应用于骨科手术的研究

The Investigation of Use of Cell Saver and Hemodilution in Orthopaedic Surgery

目的观察血液回收机行自体输血及急性等容性血液稀释在骨科手术的效果及氧代谢的变化。方法30例骨科手术患者,无明显心肺功能及凝血功能障碍,ASA分级Ⅰ～Ⅱ。年龄49.1±15.6岁,体重52.7±8.3公斤,随机分为术中自体输血组及输库血组,每组各15例。经桡动脉置管采血及右颈内静脉置漂浮导管监测血液动力学及氧代谢变化。结果自体输血组与库血输注组相比,术中出血量分别为850±443ml与775±434ml(P>0.05),术中库血输入量分别为88±202ml与380±304ml(P<0.05);两组输血前HCT分别为自体输血组23.3%±6.2%,库血组24.4%±5.9%(P>0.05)。术毕HCT分别为自体输血组28.1%±6.1%,库血组33.4%±7.2%(P>0.05)。术中自体输血及血液稀释期间外周循环阻力明显降低,心输出量明显增加,组织氧供、氧耗、氧摄取率及血乳酸无明显变化。结论骨科手术行血液回收机自体输血及血液稀释明显减少库血输注,血液稀释至23%左右对心肺功能良好的病人氧代谢状况无明显影响。

Objective To investigate the effectiveness of cell saver and acute normovolumic hemodilution(ANH) using in orthopaedic surgery and the changes inoxygenation. Methods 30 cases of selective surgical patients, ASA Ⅰ～Ⅱ degree,ages of 49.1 ± 15.6 years, body weight of 52.1 ± 8.3 kg were randomly divided into two groups. Cell saver and ANH were used in group I while allogenic transfusion was used in group Ⅱ. Catheters of artery and Swanganz were used. Hemodynamics and oxygenation were calculated via the AS/3 monitor. Results Volumes of blood loss were 850±443ml and 775±434ml respectively in group I and Ⅱ(P>0.05). Volumes of allogenic transfusion were 88±202ml and 380±304ml(P< 0.05)respectively in group I and II. Values of HCT before blood transfusion were 23.3%±6.2% and 24.2±5.9% respectively in group I and Ⅱ(P >0.05). Values of HCT after blood transfusion were 28.1%±6.1% and 33.4%±7.2% respectively in group I and Ⅱ(P>0.05). There was a significant decrease in SVR and increase in CO, but no significant changes in DO2, VO2, O2ER and lactic acid in group I. Conclusion The technique of cell saver and ANH can reduce requirement of allogenic transfusion in orthopaedic surgery and no significant changes of oxygenation were found in hemodilution up to 23% at HCT.