急性等容血液稀释在异位妊娠手术中的血液保护作用及对血气指标、凝血功能及肾功能的影响

Influences of acute normovolemic hemdilution on blood protection,blood gas indexes, blood coagulation function and renal function in ectopic pregnancy surgery

目的:探讨急性等容血液稀释(ANH)在异位妊娠手术中的节血效果及对血气指标、凝血功能和肾功能的影响。方法:90例异位妊娠手术患者随机分为观察组(n=45)和对照组(n=45)。观察组术前实施ANH;对照组不进行ANH。检测观察组ANH前后pH值、动脉血氧分压(PaO_2)、动脉血二氧化碳分压(PaCO_2)、碳酸氢根(HCO^(3-))、碱剩余(BE)及血乳酸(LAC)。于术前(T_0)、ANH后30 min(T_1)、自体血回输前(T_2)及自体血回输后(T_3)检测观察组血红蛋白(Hb)、血细胞压积(HCT)、血小板数(PLT)、纤维蛋白原(Fib)、凝血酶原时间(PT)、部分凝血活酶时间(APTT)、凝血酶时间(TT)、D-二聚体(D-D)。检测观察组术前和术后24、48 h的血清β_2微球蛋白(β_2-MG)、血尿素氮(BUN)、血肌酐(Scr)水平。比较2组围术期失血量、输血量等指标。结果:①观察组ANH后动脉血pH值、PaO_2、PaCO_2、HCO^(3-)、BE、血乳酸等血气指标较ANH前均差异无统计学意义(均P>0.05)。②观察组T_1、T_2时Hb、HCT、PLT、Fib较T_0时明显下降(P<0.05),D-D较T_0时明显增高(P<0.05),T_3时明显恢复(P<0.05)。T_1、T_2时PT、APTT、TT较T_0时差异无统计学意义(P>0.05)。③观察组术后24及48 h的β_2-MG、BUN及Cr水平较术前差异无统计学意义(P>0.05)。④观察组异体血输注量明显少于对照组(P<0.05)。结论:在异位妊娠手术中应用ANH式自体输血,对患者的血气指标、凝血功能和肾功能无明显不良影响,具有一定的节约用血效果。

Objective:To explore the influences of acute normovolemic hemdilution on blood protection,blood gas indexes,blood coagulation function and renal function in ectopic pregnancy surgery. Method:A total of 90 patients with ectopic pregnancy were divided randomly into observation group(n=45)and control group(n=45).The patients in observation group were implemented ANH and the patients in control group were not carried out ANH.PH value,arterial blood oxygen partial pressure(PaO2),arterial blood carbon dioxide partial pressure(PaCO2),bicarbonate(HCO3-),alkali residue(BE)and blood lactate(LAC)before and after ANH were detected in observation group.Hemoglobin(Hb),hematocrit(Hct),platelet count(PLT),fibrinogen(Fib),thrombin time(PT),partial thrombin time(APTT),thrombin time(TT)and D-dimer(D-D)at preoperative(T0),30 min after ANH(T1),before autogenous blood transfusion(T2)and after autogenous blood transfusion(T3)were detected in observation group.Serum β2-microglobulin(β2-MG),blood urea nitrogen(BUN)and blood creatinine(Scr)levels were detected at preoperative,postoperative 24 h and 48 h in observation group.Perioperative blood loss and blood transfusion were compared in two groups. Result:① Compared with those before ANH,PH value,PaO2,PaCO2,HCO3-,BE and LAC after ANH were no obvious changes in observation group(P>0.05).② Compared with those at T0,Hb,Hct,PLT and Fib decreased(P<0.05)and D-D increased(P<0.05)at T1 and T2,and recovered obviously at T3(P<0.05),PT,APTT and TT at T1 and T2 were no obvious changes in observation group(P>0.05).③ Compared with those at preoperative,serum β2-MG,BUN and Scr levels at 24 h,48 h after surgery were no obvious changes(P>0.05).④Allogeneic blood infusion in observation group was significantly less than that in control group(P<0.05).Conclusion:ANH had no obvious adverse effects on the blood gas index,coagulation function and renal function of patients with ectopic pregnancy,and had a certain effect of saving blood.