急性等容血液稀释对老年膝关节置换术中内环境的影响  

Effect of Acute Normovolumic Hemodilution in Elderly Patients Undergoing Replacement of Knee Joint

作　　者：牟戎[1] 吕国义[2] 邓廼封[2] 

机构地区：[1]天津市天和医院麻醉科 [2]天津医科大学第二医院

出　　处：《天津医药》2008年第11期859-862,共4页Tianjin Medical Journal

摘　　要：目的:评价急性等容血液稀释(ANH)对老年膝关节置换术患者围术期循环功能和内环境稳定的影响。方法:30例择期行膝关节置换术患者,随机分成2组,Ⅰ(对照)组、Ⅱ(ANH)组各15例。术中持续监测平均动脉压(MAP)、心率(HR)和中心静脉压(CVP)的变化;并记录2组凝血功能、动脉血气、血常规、内分泌指标及液体出入量。结果:(1)2组患者围术期生命体征平稳,Ⅱ组于血液稀释后CVP有所增高(P<0.01),但属正常范围。血液稀释过程中,Ⅱ组MAP比Ⅰ组平稳。2组患者内分泌变化差异无统计学意义(均P>0.05),但2组在松止血带后去甲肾上腺素高于基础值(均P<0.01)。(2)2组患者动脉血气差异无统计学意义(均P>0.05)。(3)Ⅱ组患者凝血酶原时间(PT)、国际标准化比值(INR)在血液稀释后延长(P<0.01),但仍在正常范围;纤维蛋白原(FIB)在血液稀释后降低(P<0.01),也仍属正常范围;术后24h、48h,2组FIB均高于术前(P<0.01),部份凝血活酶时间(APTT)在血液稀释后延长(P<0.01);Ⅱ组患者达到了中度血液稀释的目标。术后24h、48h的血红蛋白(Hb)、血细胞比客(Hct)均Ⅱ组高于Ⅰ组(P<0.01)。(4)异体输血量Ⅱ组少于Ⅰ组(P<0.01)。结论:急性等容血液稀释能安全地用于老年膝关节置换术患者,血流动力学稳定,且对内环境无明显影响,可达到不输或少输异体血的目的。Objective：To evaluate the effectiveness and safety of acute normovolumic hemodilution（ANH） in elderly patients undergoing replacement of knee joint.Methods：Thirty patients undergoing elective replacement of knee joint were enrolled in this study.The patients were randomly divided into 2 groups,control group and ANH group,with 15 cases in each group.The mean blood pressure（MBP）,heart rate（HR） and center venous pressure（CVP） were continuously monitored throughout operation.The values of blood clotting,arterial blood gas,blood routine and noradrenaline were detected in two groups.The volumes of infusion,blood adopt,blood transfusion,blood loss and urine were recorded during operation.Re-sults：（1） The vital signs were fairly stable during preoperative stage in two groups.In ANH group,CVP increased signifi-cantly after hemodilution（P 〈 0.05）.As compared with normal group MAP was more stable in ANH group.There was no significant difference in blood sugar and noradrenaline between two groups（P 〉 0.05）.（2） The values of blood gas were within normal range in two groups（P 〉 0.05）.（3） The PT and INR were significantly longer and FIB was significantly lower after hemodilution in ANH group compared with those of normal group（P 〈 0.01）.The moderate hemodilution was achieved in ANH group.（4） The volume of blood transfusion was lower in ANH group than that of normal group.Conclusion：Acute nor-movolemic hemodilution is more effective and safer in elderly patients undergoing elective replacement of knee joint.

关 键 词：血液稀释 老年人 膝关节 血流动力学过程 血液凝固 

分 类 号：R457.1[医药卫生—治疗学] R687.4[医药卫生—临床医学]