术中急性等容血液稀释对凝血功能的影响  

Effects of acute normovolemic hemodilution on the coagulation in surgical patients

作　　者：王清秀[1,2] 余开峰[1] 李颖波[1] 靳凤玲[3] 李钊 

机构地区：[1]郧阳医学院附属人民医院麻醉科,湖北省十堰市442000 [2]现在同济大学附属东方医院麻醉科 [3]北京大学第三医院麻醉科

出　　处：《临床麻醉学杂志》2007年第8期630-631,共2页Journal of Clinical Anesthesiology

基　　金：湖北省教育厅2004年重点项目(2004D004)

摘　　要：目的 观察非心脏外科手术患者应用急性等容血液稀释（ANHD）时凝血功能的变化.方法 随机选择非心脏外科手术40例,ASA Ⅰ或Ⅱ级.麻醉后常温下行ANHD,稀释后30 min（Hct 28%,T1）后行手术,手术失血再稀释至Hct 25%（T2）、Hct 23%（T3）,Hct降至23%时输自体血.于稀释前（T0）、T1、T2、T3及回输自体血后15min（T4）时测定各凝血功能参数.统计术中出血量及术后渗血量.结果 T1～T3时PT明显延长（P＜0.01）,T4时有所改善,与T3时比,差异有统计学意义（P＜0.01）.纤维蛋白原（FIB）T1～T3时与T0时比,明显降低（P＜0.05或P＜0.01）,T4时有所回升,与T3时比,差异有统计学意义（P＜0.01）.活化部分凝血活酶时间（APTT）渐延长,至T3时明显延长（P＜0.01）,T4时明显改善,与T3时比,差异有统计学意义（P＜0.05）.血小板计数（Plt）亦渐减少,T1～T4时与T0时比,差异有统计学意义（P＜0.05或P＜0.01）,T4时有所回升,与T3时比,差异无统计学意义.术中和术后出血无明显增多.结论 非心脏外科手术病人应用中深度ANHD时,凝血功能降低,回输自体血后明显改善,术中和术后渗血量无明显增加.Objective To study the effects of acute normovolemic hemodilution（ANHD） on the coagulation in surgical patients. Methods Forty adults ASA class Ⅰ or Ⅱ patients undergoing non- cardiac surgery under general anesthesia were given ANHD at normal body temperature. The hemotocrit （Hct） was hemodiluted with gelatin approximately from 39% （T0）to 28% （T1） preoperatively and to 25% （T2） and 23% （T3） during operation. Hemodynamic variables and PT, APTT,FIB,Plt were determined at each hemodilution level. Results PT and APTT were prolonged and fibringen was decreased significantly（P〈0. 01） as Hct was diluted from To to T1 ,T2 and T3. After blood reinfusion,the function of coagulation was improved to some extent,and the bleeding did not increased during and after operation. Conclusion In non-cardiac surgery patients undergoing ANHD, the function of coagulation was decreased significantly, which was improved after blood reinfusion. The bleeding did not increased intra- and postoperativly.

关 键 词：血液稀释 凝血功能 手术 

分 类 号：R614[医药卫生—麻醉学]