急性高容量血液稀释对骨科手术患者回输自体血红细胞功能的影响  

Effects of acute hypervolumic hemodilution combined with autologous transfusion salvage on function of erythrocytes in orthopedic surgery

作　　者：李建华[1] 李斌[1] 胡惠英[1] 程磊[1] 吴坛光[1] 

机构地区：[1]解放军第161医院麻醉科,湖北武汉430010

出　　处：《临床军医杂志》2013年第3期252-254,共3页Clinical Journal of Medical Officers

摘　　要：目的观察急性高容量血液稀释(AHH)对骨科手术患者回输自体血红细胞功能的影响。方法 40例择期行骨科手术患者,ASA分级Ⅱ级,采用随机数字表法均分为两组,每组20例。A组用6%羟乙基淀粉行急性高容量血液稀释联合术中自体血回输;B组单用术中自体血回输。两组术中均应用血细胞回输仪进行血液收集、回输,分别记录两组患者麻醉前(T1)、手术开始(T2)、输血前(T3)、术毕(T4)四个时点MAP、CVP、HR、Hb及Hct变化;记录患者术中回收血量、异体浓缩红细胞量及血浆用量;监测回输自体血红细胞变形能力(IF)及红细胞2,3二磷酸甘油酸(2,3-2DPG)含量。结果手术过程中A组输注异体浓缩红细胞量及血浆用量明显少于B组(P<0.05);A组行AHH后Hb、Hct较麻醉前明显下降(P<0.05),与B组比较也明显降低(P<0.05);两组患者四个时点MAP、CVP、HR比较无统计学差异(P>0.05);A组血细胞回输仪所收集回输红细胞IF值较B组明显降低(P<0.05),而2,3-2DPG较B组明显增高(P<0.05)。结论术前采用急性高容量血液稀释能有效维持循环,增加回输血红细胞变形能力和氧释放,从而改善组织血流灌注,增加组织氧供。Objective To evaluate the effect of acute hypervolumic hemodilution （AHH） combined with autologous transfusion sal- vage on function of erythrocytes in orthopedic surgery. Methods Forty patients for orthopedic surgery, aged 20 - 50 years, ASA 11 were randomly divided into two groups （n = 20 each）. Group A was given AHH plus autologous transfusion salvage with 6% Hydroxyethyl starch and Group B was given autologous transfusion salvage alone. MAP, CVP, HR, Hb and Hct were recorded at the time points of before anesthesia （ TI ） , immediately after operation （ T2 ） , before transfusion （ T3 ） and after operation （ W4 ）. The volume of blood recovery, erythrocyte suspension and plasma were counted. Erythrocyte filterability index and content of eryth- rocyte 2, 3-2-diphosphoglyceric acid were measured before transfusion. Results The volume of erythrocyte suspension and plasma were significantly higher in Group B than in Group A （ P 〈 0.05 ）. Hb and Hct in Group A after AHH was significantly lower than that before anesthesia （ P 〈 0.05 ）, and also lower than in Group B （ P 〈 0.05 ）. No statistical difference was found in MAP, CVP and HR in two groups between T1 - T4 （ P 〉 0.05 ）. IF was significantly lower in Group A than in Group B before transfusion （ P 〈 O. 05 ）. Content of erythrocyte 2, 3-2diphosphoglyceric acid was significantly higher in Group A than in Group B before transfusion （ P 〈 0.05 ）. Conclusion AHH and autologous blood transfusion can effectively salvage autologous blood in time, maintain hemo- dynamic stability and has a great effect on the oxygen supply of erythrocytes.

关 键 词：自体 输血 血液回收 高容量血液稀释 

分 类 号：R681[医药卫生—骨科学]