急性等容量血液稀释在骨关节手术中应用  

Acute Normovolaemic Hemodilution during Elective Osteoarticular Surgery

作　　者：王建珍[1] 薄志华[1] 李蔚波[1] 祁喆[1] 李国燕[1] 

机构地区：[1]上海市第二人民医院麻醉科,上海200011

出　　处：《中国临床医学》2010年第2期254-256,共3页Chinese Journal of Clinical Medicine

摘　　要：目的:观察急性等容量血液稀释(ANH)在骨关节手术中的节约用血效果。方法:择期行骨科大手术患者18例,随机分成两组:C组(n=9)为对照组,在手术前不进行血液稀释;ANH组(n=9)为研究组,在麻醉后手术前进行等容量血液稀释。患者麻醉诱导后手术开始前进行ANH。放血量(V)=患者预计血容量(EBV)×[放血前血细胞压积(H0)-允许最低血细胞压积(Hf)]/H0和Hf的均值(Hctav),本研究中允许最低血细胞压积为25%。连续监测血压、心率和心律、脉搏氧饱和度,记录术中尿量,出血量、输血补液量,术毕、术后24h及72h分别查血红蛋白(Hb)、血细胞压积(Hct)、血小板计数(Bpc)。结果:ANH组平均采血量为(883±204)mL,稀释后Hct平均为(27.67±4.86)%,对照组输异体血的量明显高于ANH组,而输液量明显低于ANH组。两组手术结束时及术后24h、72h的Hb、Hct都较术前有明显降低。ANH组血液稀释后Bpc有减少趋势,而对照组同一时点无明显改变。结论:骨科大手术中失血较多,ANH是节约用血的有效方法。Objective：To investigate the effect of acute normovolaemic hemodilution（ANH） for reducing the use of allogeneic blood during osteroarticular surgery. Methods：18 patients undergoing elective surgery were divided into two groups randomly：group C （contrast,n=9） and group ANH（n=9）. In group C acute normovolaemic hemodilution was not implied after induction of anesthesia. In group ANH,acute normovolaemic hemodilution was initiated after induction of anesthesia. ANH was performed after induction of anesthesia but before the start of surgery. To determine the patient＇s blood volume to be withdrawing before operation,we used the original equation of Gross：VL=EBV×[Hct0-Hctf]/ HctAV,VL=blood volume to be withdrawn,EBV=estimated total blood volume of patient,Hct0=initial Hct,Hctf=patient＇s minimal allowable Hct,HctAV=average of Hct0 and Hctf. According the equation of Gross,the volume of blood collected was dependent on the preoperative Hct value. The target Hct in this study was 25%. Perioperative monitoring included continuous arterial pressure measurement,ECG,pulse oximetry,and record urine output,the amount of blood loss、allogeneic blood and fluid introperative,. Haemoglobin,Hct,platelet count were measured at the end of operation、the first day and the third day after operation. Results：Mean amount of Autologous blood was 883±204ml,Mean Hct was 27.67±4.86% after dilution. The amount of allogeneic blood was lower in group ANH. But the amount of fluid was much in group ANH. Hb、Hct at the end of operation、the first day and the third day after operation were lower than the preoperation in both groups. Platelet count have a trend to decrease in group ANH.Conclusions：Acute normovolaemic haemodilution is an effective blood conservation strategy during osteroarticular surgery. It can evidently reduce the administration of allogeneic blood.

关 键 词：等容量血液稀释 骨科手术 

分 类 号：R459.9[医药卫生—治疗学]