中度急性等容性血液稀释对肝脏手术凝血功能、D-二聚体和出血量的影响  

The Effects of Acute Normovolemic Hemodilution on Coagulative Function,D-dimer and Blood Loss During Hepatic Surgery

作　　者：林健清[1] 林财珠[1] 杨庆[1] 

机构地区：[1]福建医科大学附属医院

出　　处：《中西医结合心脑血管病杂志》2006年第4期290-292,共3页Chinese Journal of Integrative Medicine on Cardio-Cerebrovascular Disease

基　　金：福建省卫生厅青年科研基金立项项目(No.2003-2-6)

摘　　要：目的探讨等容性血液稀释对肝脏手术凝血功能、D-二聚体和出血量的影响,为阐明等容性血液稀释在肝脏手术中的应用安全性提供依据。方法选择术前无心肺肾疾病、贫血、水电解质异常、血液疾病和应用抗凝药物,血红蛋白(Hb)≥110g/L的肝脏手术病人40例随机分为两组(每组20例):Ⅰ组为对照组,Ⅱ组为等容性血液稀释组;所有行等容性血液稀释病人均经肘部静脉或其他大静脉采血,放血时间为15min^30min,血液存于含PCD的采血袋;下肢同步输注同容量6%贺斯,直到红细胞比容(Hct)降至25%~30%,并维持血流动力学稳定,所采集的血液室温保存于手术间,结合术中失血量和循环情况在手术结束前行自体输血;分别于麻醉前及等容性血液稀释后30min、60min、手术结束时和手术后12h,采静脉血测定血小板计数(PLC)、凝血酶原时间(PT)、凝血酶时间(TT)、D-二聚体和Hct。结果Ⅱ组术中出血量较I组减少(P<0.05);Ⅱ组采血后和术中PT、TT较I组显著延长(P<0.05或P<0.01),PLC显著下降(P<0.05或P<0.01),但仍在生理范围内,回输自体血后上述指标明显恢复,手术野和切口无异常出血;两组D-二聚体无明显改变(P>0.05)。结论术前对肝脏手术病人进行急性等容性血液稀释至Hct值降至25%~30%是安全的,对凝血功能和纤溶系统无明显影响,且可减少术中出血量。Objective To evaluate the effects of acute normovolemic hemodilution on coagulative function, D- dimer and blood loss during hepatic surgery and investigate the feasibility of acute normovolemic hemodilution during hepatic surgery. Methods Forty ASAI-Ⅱpatients scheduled for hepatic surgery were divided into two groups： Group Ⅰ（control group, n = 20） ; Group Ⅱ（hemodulitive group, n = 20）. Hemodilution was achieved by the removal of blood from elbow vein or other vein during 15 - 30 minutes and replacement with same volume of 6 % IDES. PLC, PT, TT, D - dimer and Hct were measured before anesthesia, 30 min and 60 min after hemodilution, operation end and 12 h after operation. Results The blood was less in group Ⅱthan that in group I （ P 〈 0.05 ） ; PT and TT increased more significandy（P 〈 0.05 or P 〈 0.01 ） after hemodilution and during operation in groupⅡ than that in group I. PLC decreased significantly,but still within the normal range and D - dimer had no significant change. Conclusion Acute normovolemic hemodilution during hepatic surgery had no significant influence on coagulative function and fibrolysis system, which was a safety method for blood protect.

关 键 词：血液稀释 D-二聚体 出血量 凝血酶 原时间 凝血酶时间 

分 类 号：R657.3[医药卫生—外科学] R614[医药卫生—临床医学]