急性非等容血液稀释对高龄全髋置换患者围术期凝血功能的影响  

Effect of Acute Non-isovolemic Hemodilution(ANIH) on the Coagulation and Formation of Deep Venous Thrombosis(DVT) in Total Hip Arthroplasty(THA)

作　　者：邬露丹[1] 顾异香[2] 穆银玉[1] 刘涓[3] 陈兵华[1] 黎丽[1] 

机构地区：[1]宁波大学医学院附属李惠利医院检验科,315040 [2]宁波大学医学院附属李惠利医院骨科,315040 [3]宁波大学医学院附属李惠利医院麻醉科,315040

出　　处：《医学研究杂志》2013年第1期95-98,共4页Journal of Medical Research

基　　金：宁波市科技计划项目(2010C50030)

摘　　要：目的观察急性非等容血液稀释(acute non-isovolemic hemodilution,ANIH)对高龄全髋关节置换术患者围术期凝血功能及术后深静脉血栓(deep venous thrombosis,DVT)形成的影响。方法将符合条件的择期手术患者60例,随机等分为ANIH组(A组)和对照组(B组),检测患者在麻醉诱导前、ANIH后30min、术毕、术后1天和术后3天的凝血功能和D-D二聚体(DD)变化;B组在相应时点监测同一指标。结果血液稀释后A组患者的凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)值显著延长,但仍在正常范围以内,回输自体血后指标得到一定改善;两组的纤维蛋白原(FIB)在血液稀释后有不同程度的降低,至术后1天逐渐恢复,术后3天时B组的FIB上升明显高于A组和麻醉诱导前;两组的DD在术毕与术前比较差异有统计学意义(P<0.01),但A、B两组间无差异,另外,术后1天起,A组的DD逐渐下降,B组的DD明显上升,两组比较有统计学意义(P<0.01)。结论术前行ANIH能安全地用于高龄全髋置换术患者,有预防血栓形成的作用,同时监测患者术后的FIB和DD水平能对临床早期进行抗栓治疗提供帮助。Objective To observe the effect of acute non - isovolemic hemodilution （ANIH） on the coagulation and formation of deep venous thrombosis （DVT） in total hip arthroplasty（THA）. Methods Sixty qualified patients were divided into ANIH group （group A） and control group（ group B） , and we examined the changes of coagulation and D - dimer before anesthesia, 30min after ANIH, after operation, ld after operation and 3d after operation. Results After hemodilution, the PT and APTT of group A were significantly prolonged within normal level and improved relatively after autotransfusion. The FIB of both groups decreased differently after ANIH, and recovered gradually ld after operation, 3d after operation. The FIB of group B was significantly higher than that of group A, and it was also much higher than that before anesthesia（P 〈 0.01 ）. The D - dimer of both groups was of statistical significance after operation as compared with that before anesthesia（ P 〈 0.01 ） , but there was no significant difference between the two groups. In addition, the D - dimer of group A gradually decreased 1 d after operation, but it markedly increased in group B, and there was statistic significance between the two groups （P 〈 0.01 ）. Conclusion ANIH before THA on elderly patients could effectively prevent thrombosis formation. At the same time, monitoring the level of FIB and D - dimer after operation would contribute to the early treatment of thrombosis prevention.

关 键 词：急性非等容血液稀释 全髋关节置换术 凝血功能 

分 类 号：R651.11[医药卫生—外科学]