术前急性超容性血液稀释(AHHD)对术后安全性的临床观察  

Clinical Observation of Preoperative Acute Hypervoemic Hemodilution on Postoperative Safety

作　　者：刘艳萍[1] 于文华[1] 胡建军[1] 

机构地区：[1]新疆医科大学附属肿瘤医院ICU麻醉科,新疆乌鲁木齐830011

出　　处：《新疆医学》2011年第9期8-11,共4页Xinjiang Medical Journal

摘　　要：目的:术前急性超容性血液稀释(AHHD)对术后安全性的临床观察。方法:选择ASAI-H级、FEVl%I-Ⅱ级、无肝肾功能损害手术患者共140例,其中70例作术前急性超容性血液稀释(AH-HD),70例为对照组。观察AHHD前(T0),AHHD完毕(T1),术毕(T2),术后第一天(T3)血流动力学、血常规、血气分析、凝血四项、及电解质变化,两组分别统计术后48h内低血压、心律失常、急性心力衰竭、急性呼吸衰竭、出血、肝肾功能损害发生例数。结果:AHHD组与对照组之间在血流动力学方面,T2中HR、MAP变化明显(P<0.05),T1中CVP变化明显(P<0.05);AHHD组与对照组之间在血常规方面,T1中Hb与Hct变化明显(P<0.05);AHHD组与对照组之间在电解质及血气分析方面,Tl中K+与Ca2+变化明显(P<0.05);AHHD组与对照组之间在凝血功能变化,T1中PT、APTT、FIB变化均明显(P<0.05),T2中APTT及T3中FIB两组之间均有差异(P<0.05)。术后48h各并发症中,AHHD能明显减少肝肾功能损害的发生(P<0.05)。结论:AHHD是预防外科术中出血量多,麻醉实施的一种节约用血的方法。通过临床对照研究,对术后安全性无明显影响,故值得在临床实践中推广。Objective： To observe the preoperative acute hypervolemic hemodilution （AHHD） on postoperative clinicalsecurity. Methods：To select 140 patients with ASA grade I - II ,FEV1% grade I - II , without liver and kidney disfunetion. 70 patients of whom were in AHHD group and the other 70 patients were in control group. To survey hemodynamies, blood routine test, arterial blood gas, blood clotting test and electrootes at before AHHD （T0） , after AHHD （ T1 ）, postoperation （ T2）, the 1st day postoperation （ T3 ）, to add up the incidence of hypotension, arrhythmia, acute heart failure, acute respiratory failure, hemorrhage, liver and kidney dysfunction postoperation in 48 hours. Results：There existed statistics difference between the two groups, such as follows ： HR and MAP at T2 （ P 〈 0.05）, CVP at T1 （ P 〈 0.05 ） in hemodynamics, Hb and Hct at T1 （ P 〈 0.05 ） in blood routine test, K ＋ and Ca2 ＋ at T1 （ P 〈 0.05 ） in arterial blood gas and electrolytes, PT, APTT, FIB at T1 （ P 〈 0.05 ）, APTT at T2 （ P 〈 0.05 ）, FIB at T3 （ P 〈 0.05 ） in blood clotting test. Postoperative complications in 48 hours, the incidence of liver and kidney dysfunction was lower in AH-HD group. Conclusions：AHHD could prevent hemorrhage in operation, save blood transfusion. On the base of our research, the incidence postoperative complications wouldnt increase,it deserve to spread in clinical practice.

关 键 词：急性超容性血液稀释 外科手术 术后安全性 

分 类 号：R619[医药卫生—外科学]