急性等容血液稀释对老年肝癌病人围手术期凝血和纤溶功能的影响  

Effects of acute normovolemic hemodilution on coagulation and fibrinolysis in eldly patients undergoing hepatic carcinectomy

作　　者：郭建荣[1] 喻君[1] 杜金满[1] 金孝岠[2] 郭伟[1] 袁晓红[1] 

机构地区：[1]宁波大学医学院附属李惠利医院麻醉科,浙江宁波315040 [2]皖南医学院附属弋矶山医院麻醉科,安徽芜湖241000

出　　处：《中国实用外科杂志》2010年第11期949-951,共3页Chinese Journal of Practical Surgery

基　　金：宁波市医学科技基金项目(200612)

摘　　要：目的观察急性等容血液稀释(ANH)用于老年肝癌切除手术时对凝血和纤溶功能的影响。方法选择2007年2月至2008年2月在宁波大学医学院附属李惠利医院行肝脏肿瘤切除手术的老年病人30例,对其围手术期凝血和纤溶功能影响的临床资料进行分析。将30例随机等分为ANH组(A组)和对照组(B组)。结果两组病人围手术期出血量差异无统计学意义(P>0.05),A组异体血需求量(350.0±70.7)mL比B组(457.0±181.3)mL明显减少(P<0.01);两组在ANH30min后凝血酶原时间(PT)、活化部分促凝血酶原激酶时间(APTT)值与麻醉诱导前比较显著延长,但仍在正常范围以内,A组回输自体血后指标得到一定改善;两组病人凝血指标凝血酶时间(TT)、D-二聚体(DD)组间比较差异无统计学意义(P>0.05)。两组病人围手术期的可溶性纤维蛋白单体复合物(SFMC)、凝血酶原片段1+2(F1+2)各时点组间比较差异无统计学意义(P>0.05);与麻醉诱导前比较,A组病人ANH后30min至术毕时间血小板膜糖蛋白(CD62P)表达明显低于B组(P<0.05),两组各时点组内比较差异无统计学意义(P>0.05)。结论 ANH对老年肝癌切除病人围手术期的纤溶和凝血功能无显著影响,并可明显减少异体输血。Objective To observe the effects of acute normovolemic hemodilution （ANH） on coagulation and fibrinolysis on eldly patients undergoing hepatic carcinectomy. Methods Thirty liver cancer patients （ASA Ⅰ or Ⅱ） over sixty years old performed hepatic carcinectomy fi＇om February 2007 to February 2008 at Lihuili Hospital, Medical College of Ningbo University were randomly divided into ANH group （groupA, n=15） and control group（group B, n= 15）. Results The perioperative blood loss was not significantly different between the two groups （P〉0.05）. The volume of allogeneic blood transfusion in ANH group was significantly less than that in control group [（ 350.0±70.7 ）mL vs. （457.0±181.3 ）mL, P〈0.01 ]. Compared with before anesthesia induction, PT and APTF in both groups prolonged significantly at 30 minutes after ANH, but they all remained in normal range. TF and DD had no significant changes between the two groups. SFMC and F1 ＋2 increased in both groups, but without statistical significance. PAC-1 and CD62P expressions of ANH group were significantly lower than before anesthesia induction （P〈0.05）. Compared with group B, CD62P were significantly lower in ANH group after ANH. But there was no statistical significance between the two groups（P〉0.05）. Conclusion In elderly patients undergoing resection of liver cancer, ANH has no obvious impact on fihrinolysis and coagulation function. It could therefore be safe to reduee allogeneie blood transfusion largely.

关 键 词：肝癌 急性等容血液稀释 凝血功能 

分 类 号：R6[医药卫生—外科学]