非等容血液稀释对全髋置换术患者血浆蛋白的影响  

Effect of ANIH on plasma protein of total hip arthroplasty patients

作　　者：邬露丹[1] 俞璐敏[1] 李情操[1] 孙琦[1] 刘涓[2] 章慧斌[3] 

机构地区：[1]宁波市医疗中心李惠利医院检验科,浙江宁波315040 [2]宁波市医疗中心李惠利医院麻醉科,浙江宁波315040 [3]宁波市医疗中心李惠利医院骨科,浙江宁波315040

出　　处：《中国现代医生》2013年第14期82-84,88,共4页China Modern Doctor

基　　金：浙江省宁波市科技计划项目(2010C50030)

摘　　要：目的观察高龄全髋关节置换术患者应用羟乙基淀粉行急性非等容血液稀释后围术期血浆蛋白浓度的变化。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30 min、术毕、术后1 d和术后3 d血清中总蛋白(total protein,TP)、白蛋白(albumin,ALB)、C-反应蛋白(C-reactive protein,CRP)及前白蛋白(pre-albumin,PA)浓度的变化;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TP、ALB、PA均显著下降,与麻醉诱导前和B组比较差异有统计学意义(P<0.01),在回输自体血后TP、ALB开始回升;术后1 d,两组的PA逐渐回升,CRP显著上升;术后3 d,两组的TP、ALB都有较大程度的升高,且A组的上升程度与B组比较,差异有统计学意义(P<0.05),两组的CRP、PA都有明显恢复,但与麻醉诱导前比较差异仍有统计学意义(P<0.01),而两组间比较差异无统计学意义(P>0.05)。结论术前应用6%的羟乙基淀粉(万汶)行ANIH能安全地用于高龄全髋关节置换术患者,减少了患者围术期血浆蛋白的丢失,有利于患者术后的康复;同时,羟乙基淀粉的应用在一定程度上缓解了创伤引起的机体的应激反应。Objective To observe the effect of acute non-isovolemie hemodilution （ANIH） on the concentrations of plasma protein in total hip arthroplasty on elderly patients. Methods Sixty qualified patients were divided into ANIH group （group A） and control group （group B）, and examined the changes of concentrations of plasma protein before anesthesia, 30 mins after ANIH, at the end of operation, ld after operation and 3d after operation. Results After hemodilution, the concentrations of TP, ALB, PA of group A significantly decreased, there were statistical difference with group B as compared with before anesthesia （P 〈 0.01）. The concentration of TP, ALB of group A recovered gradually after autotransfusion. After operation one day, PA began to pick up and CRP increased significantly of both groups. Three days after operation, the concentrations of TP, ALB of both groups recovered a lot, and the increasing of TP, ALB of group A was significantly-higher than that of group B, which had statistical difference （P 〈 0.05）, the level of CRP and PA of both groups recovered remarkably ,they were still significantly different with those before anesthesia （P 〈 0.01）, however, there was no statistical difference between two groups （P 〉 0.05）. Conclusion Before operation, acute non-isovolemic hemodilution with 6% hydroxyethyl starch can be safely applied on elderly patients undergoing total hip arthroplasty, it can reduce the loss of plasma proteins, and it is beneficial for the patients to get well after operation, to a certain extent ,it also has relieved the stress reaction by wound.

关 键 词：急性非等容血液稀释 全髋置换术 血浆蛋白 

分 类 号：R614[医药卫生—麻醉学]