急性ANH联合低中心静脉压对肝癌手术患者凝血功能的影响  

Effects of acute normovolemic hemodilution plus low central venous pressure on coagulation function in patients undergoing liver cancer resection

作　　者：吴志云[1] 查本俊[1] 邓莎[1] 王永盛[1] 谢平[1] 

机构地区：[1]中国人民解放军第一八O医院麻醉科,福建泉州362000

出　　处：《中国普通外科杂志》2014年第1期28-32,共5页China Journal of General Surgery

摘　　要：目的:观察急性等容血液稀释(ANH)联合低中心静脉压(ANH+LCVP)在肝癌手术中对患者凝血功能的影响。方法:40例ASA I^II级拟行肝癌切除手术患者随机均分为观察组与对照组,观察组于全麻后行ANH,入室到肝实质横断分离完成前行控制性LCVP,对照组按常规处理。记录患者术中、术后的出血量和术后因腹腔出血需再次手术的患者例数,以及不同时间点患者的血红蛋白(Hb)、红细胞压积(HCT)、血小板(PLT)、纤维蛋白原(FIB)、活化部分凝血酶时间(APTT)、凝血酶原时间(PT)、国际标准化比例(INR),凝血时间(ACT)、血块凝结速率(CR)、血小板功能(PF)等。结果:观察组患者术中出血量明显少于对照组(P<0.05),而术后出血量两组间差异无统计学意义(P>0.05),两组均无因继发性出血而再次手术的患者;观察组在采血后、肝癌切除后、恢复容量后Hb、HCT、PLT、FIB、CR、PF较术前均明显下降,APTT、PT、INR、ACT较术前均明显升高,但恢复容量后比肝癌切除前各指标均明显改善(P<0.05);对照组患者从手术开始至结束,Hb、HCT、PLT、FIB、CR、PF呈进行性降低,APTT、PT、INR、ACT呈进行性升高;手术结束后观察组各项指标明显较对照组改善(P<0.05)。结论:ANH+LCVP能够减少术中出血,对患者的凝血功能有一定的影响,但是不会导致异常出血,可以安全应用肝癌手术中。Objective： To investigate the effects of acute normovolemic hemodilution plus low central venous pressure （ANH＋LCVP） on coagulation function in patients undergoing liver cancer resection. Methods： Forty liver cancer patients with ASA I-II physical status scheduled for liver resection were equallydesignated to observational group and control group. Patients in observational group underwent ANH after general anesthesia, and controlled LCVP was performed from the time that the patients entered the operating room to the completion of liver parenchyma transection, while those in control group received the conventional treatment onl. The intra- and postoperative blood loss, the number of patients undergoing second operation due to intra-abdominal hemorrhage, and the parameters that included hemoglobin （Hb） level, hematocrit （HCT）, platelet （PLT） count, fibinoger （FIB） concentration, activated partial thromboplastin time （APTF）, prothrombin time （PT）, and international normalized ratio （INR） as well as activated dotting time （ACT）, clot rate （CR） and platelet function （PF） in different time points were recorded. Results： The intraoperative blood loss in observational group was significantly less than that in control group （P〈0.0S）, but the postoperative blood loss showed no significant difference between the two groups （P〉0.05）, and no case of either group required a second operation due to secondary hemorrhage. In observational group, the values of Hb, HCT, PLT, FIB, CR and PF were significantly decreased while the values ofAPTT, PT, INR and ACT were significantly increased at the time after blood collection, after liver cancer resection, and after intravascular volume restoration compared with their values before surgery, but these parameters were obviously improved after intravascular volume restoration compared to that after liver cancer resection. In control group, the values of lib, HCT, PLT, FIB, CR and PF were progressively decreased while the value

关 键 词：肝切除术 肝肿瘤 血液稀释 降压 控制性 

分 类 号：R675.3[医药卫生—外科学]