骨科手术中急性非等容性血液稀释-止血药-自体血回收联合应用的血液保护效果  

Blood-saving efficacy of acute non-isovolemic hemodilution-hemostatics-intraoperative blood salvage in patients undergoing orthopedic surgery

作　　者：易明亮[1] 颜渊[1] 杨勇[1] 吴爱玲[1] 欧阳胜[1] 黄辉[1] 何旭东[1] 

机构地区：[1]内江市第一人民医院麻醉科,64100

出　　处：《中国急救复苏与灾害医学杂志》2013年第1期45-48,共4页China Journal of Emergency Resuscitation and Disaster Medicine

摘　　要：目的评价急性非等容性血液稀释（ANIH）-止血药-自体血回收联合应用在骨科手术中血液保护效果。方法选择择期手术患者120例，性别不限，年龄18～66岁，ASAI一Ⅱ级，预计术中出血量大于600ml，随机分为4组（n=30）：ANIH-血液回收-止血药组（A组），血液回收-止血药组（B组），ANIH-止血药组（c组），血液回收组（D组）。ANIH：全麻诱导前采血，采血量为患者血容量15％。止血药：切皮前10min静脉注射用尖吻腹蛇血凝酶2u。记录术中输液量、尿量、出血量、异体血输血量及输血例数；记录术前、术毕、术后24h血常规、凝血常规和血流动力学指标。结果各组PT、APTT值术毕和术后24h与基础值比较有明显升高（P〈0．05），其余血常规及凝血功能指标与基础值比较有明显降低（P〈0．05）。与A组相比D组异体输血量明显增多（P〈0．05）。结论骨科手术患者ANIH＋血液回收＋止血药联合应用有较好的血液保护作用，并且安全陛高，可在临床上推广。Objective To evaluate the blood saving efficacy of an acute non-isovolemic （ANIH）＋ hemostatics ＋ intraoperative blood salvage （IOBS） in patients undergoing orthopedic surgery. Methods 120 ASA Ⅰ-Ⅱ patients with age between 18 and 66 years old scheduled for elective orthopedic surgery under general anesthesia with expected blood loss of 600 ml or more, were randomly divided into 4 groups （n=30 each）： ANIH＋ hemostatics ＋IOBS group, IOBS ＋ hemostatics group, ANIH ＋hemostatics group, and IOBS group. ANIH that involved withdraw of blood 15% total blood volume was performed before anesthesia induction. Haemocoagulase Agkistrodon 2kU was injected 10 minutes before skin incision. The total volume of fluid intake and output, urine volume, volume of bleeding, blood transfusion, HR, MAP and CVP were recorded during the operation. Vein blood samples were taken for determination of lib, Hct, platelet counts （Plt）, prothrombin time （PT）, activated partial thromboplastin time（APIT）, and fibrinogen concentration（Fib）. Results In all groups the value of PT and APTT at completion of operation and 24 hour after were significantly higher than that of the base time （P〈0.05）, on the contrary the other values of blood routine and coagulation conventional were significantly lower than that of the base time （P〈0.05）. In D group the allogenic blood transfusion was higher than that in A group （P〈0.05）.Conclusion The blood-saving efficacy of ANIH-hemostatics-lOBS is considered as being protective and safe.

关 键 词：血液稀释 止血药 输血 自体 

分 类 号：R973.1[医药卫生—药品]