急性等容血液稀释联合控制性低中心静脉压对肝叶切除术患者凝血功能和术中出血量的影响  

Acute normovolemic hemodilution combined with controlled low central venous pressure on coagulation function and blood loss in patients undergoing hepatic resection

作　　者：沈华春[1] 郭建荣[2] 徐峰[1] 张义伟[1] 邵怡[1] 苏永俊 

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]上海市浦东新区公利医院麻醉科,上海200135

出　　处：《中国输血杂志》2012年第5期439-442,共4页Chinese Journal of Blood Transfusion

基　　金：宁波市科技局项目(2010C50028);宁波市医学科技基金项目(2010A01)

摘　　要：目的探讨急性等容血液稀释(ANH)联合控制性低中心静脉压(LCVP)对肝叶切除术患者凝血功能和术中出血量的影响。方法 60名择期在全麻下行肝叶切除术患者随机分为对照组(Ⅰ组)、LCVP组(Ⅱ组)和ANH联合LCVP组(Ⅲ组)3组,每组20例。Ⅰ组常规处理不行ANH或LCVP;Ⅱ组开腹后至肝实质离断期间实施LCVP,维持CVP 2～5 cmH2O;Ⅲ组麻醉诱导后行ANH,其他处理同Ⅱ组。观察3组患者不同时点凝血功能指标的变化,记录术中出血量、异体输血量及异体输血例数。结果与Ⅰ组比较,Ⅱ组和Ⅲ组出血量、异体输血量和异体输血例数明显减少(P<0.05);与Ⅱ组比较,Ⅲ组异体输血量和异体输血例数明显减少(P<0.05)。3组各时点凝血功能指标均在正常范围内。结论 ANH与LCVP联合应用于肝叶切除术,能明显减少术中出血和异体输血,且对凝血功能无明显不利影响。Objective To investigate effect of acute normovolemic hemodilution（ANH） combined with controlled low central venous pressure（LCVP） on coagulation function and blood loss in patients undergoing hepatic resection.Methods Sixty ASAⅠorⅡ patients,aged 35~71yr,body mass index（18~28）kg/m2,scheduled for hepatic resection,were randomly divided into 3 groups（n=20 each）：control group（group Ⅰ）,LCVP group（group Ⅱ） and ANH combined with LCVP group（group Ⅲ）.Group Ⅰreceived no ANH and LCVP.In group Ⅱ,CVP was maintained at 2~5 cmH2O until hepatic parenchymal transaction.In group Ⅲ,ANH was used after intubation,the other dealing was given the same as the group Ⅱ.The blood samples were taken from internal jugular vein for determination of the index of blood coagulation function,such as prothrombin time（PT）,activated partial thromboplastin time（APTT）,thrombin time（TT） and plasma fibrinogen concentration（FIB） before anesthesia（T0）,30 min（T1）,60 min（T2） after hemodilution and at the end of surgery（T3）.Intraoperative blood loss and blood transfusion were measured.Results Intraoperative blood loss,blood transfusion and the number of blood transfusion were greater in group Ⅰthan in the other groups.Blood transfusion and the number of blood transfusion were less in group Ⅲ than in groupⅡ（P〈0.05）.All the parameters of coagulation function in the three groups were in the normal ranges.Conclusion Moderate ANH combined with LCVP can decrease intraoperative blood loss but does not affect coagulation function in patients undergoing hepatic resection.

关 键 词：血液稀释 低中心静脉压 肝叶切除 失血 凝血功能 

分 类 号：R457.1[医药卫生—治疗学] R657.3[医药卫生—临床医学]