等容性血液稀释加自体血回收在全髋置换术中的应用  

The clinical use of acute normovolaemic haemodilution combined with intraoperative salvage of shed blood in total hip replacement

作　　者：苑贵敏[1] 牛捷平[1] 章彦[1] 孙晓雄[1] 

机构地区：[1]北京积水潭医院麻醉科,100035

出　　处：《北京医学》2004年第4期241-243,共3页Beijing Medical Journal

摘　　要：目的　探讨全髋置换术中自体血回收加等容性血液稀释 (ANH)的可行性并与单纯术中自体血回收做比较。方法　择期全髋置换术 2 4例 ,随机分为两组。实验组 :1 2例 ,术中自体血回收 +ANH ;对照组 :1 2例 ,术中自体血回收。分别监测采血前、采血后即刻、术毕、术后 1d的Hb、红细胞压积 (HCT)、血小板 (PLT)及凝血功能[凝血酶原时间 (PT)、活化部分凝血活酶时间 (APTT) ],观察术中失血及输血情况。结果　采血后即刻实验组Hb、HCT、PLT降低 ,与对照组比较有非常显著性差异 (P <0 .0 1 ) ,PT、APTT明显延长 (P <0 .0 5 )。两组术中失血量无明显差别。实验组无一例输库血 ,对照组 4例需输异体血 ,两组比较有显著性差异 (P <0 .0 5 )。结论　ANH加术中自体血回收是减少全髋置换术中失血及输血的有效方法。Objective To investigate the effects of acute normovolaemic hemodilution(ANH) combined with cell saver and to compare it with the efficacy of intraoperative salvage of shed blood in total hip replacement.Methods 24 patients undergoing selective total hip replacement were randomized to two groups.Test group (n=12):ANH combined with shed blood saved intraoperatively.Control group (n=12):in traoperative salvage of shed blood separately.The Hb,HCT,PLT and coagulation parameters (PT,APTT) were monitored before ANH,immediately after ANH,and the first day after operation separately.The blood loss and allogeneic blood transfusion during operation were also recorded.Results Hb,HCT and PLT were all reduced immediately after surgery and the first postoperative day in two groups ( P <0.01).There was no significant difference in coagulation parameters between these two groups( P >0.05).Nobody in ANH group among 12 patients received allogeneic blood transfusion.There was significant statistic difference compared with control group in which transfusions were given to 4 of 12 patients(33%)( P <0.05).Conclusions ANH combined with imtraoperative salvage of shed blood is a safe and effective technique which can reduce blood loss and allogeneic transfusion during total hip replacement.

关 键 词：等容性血液稀释 自体血回收 全髋置换术 ANH 凝血功能 

分 类 号：R614[医药卫生—麻醉学]