中度等容性血液稀释联合术中血液回收对骨科手术术中术后凝血功能的影响  

Combination of autologous techniques do not affect intraoperative and postoperative coagulation function in patients undergoing spine surgery

作　　者：洪涛[1] 孟凌新[1] 刘齐[1] 田甜[1] 王欢[1] 王秋实[1] 

机构地区：[1]中国医科大学附属盛京医院,辽宁沈阳110004

出　　处：《中国现代医学杂志》2014年第17期79-82,共4页China Journal of Modern Medicine

摘　　要：目的探讨中度等容性血液稀释联合术中血液回收对骨科手术术中术后凝血功能的影响。方法自身前后对照实验,择期拟在全身麻醉下行胸椎或腰椎椎板减压、间盘切除、椎间植骨并椎弓根钉内固定术的患者10例,ASAⅠ、Ⅱ级,年龄23~61岁,体质量50~85 kg,预计出血量800~1 500 mL。麻醉诱导后行中度等容性血液稀释（ANH）至预计HCT 30%,术中联合使用瑞芬太尼及七氟烷控制性降压,维持MAP于70~80 mmHg之间,同时使用血液回收机回收术中失血。Hb下降至70 g/L或术中主要操作结束预计再无大量出血时回输自体血。记录ANH后及自体输血完成后血栓弹力图各项指标,术前、ANH后、自体输血完成后、术后1、2、3 d的HB、HCT、PLT、APTT、PT、TT、FIB值。结果等容性血液稀释后HB和HCT均明显下降（P〈0.05）。与ANH后比较,自体输血完成后、术后1、2、3d HB与HCT比较,差异无统计学意义（P〉0.05）。血栓弹力图示均为正常凝血功能,与ANH后相比,自体输血完成后R值缩短（P〈0.05）。凝血功能指标均在正常范围内,无统计学意义（P〉0.05）。结论中度等容性血液稀释联合术中血液回收可以显著减少异体血液制品的输注,同时不影响术中术后凝血功能。【Objective】 To investigate if combination of autologous techniques affect intraoperative and postoperative coagulation function during and after spine surgery. 【Methods】 Ten ASA Ⅰ ~ Ⅱ patients,weighing 50 ~ 85 kg, undergoing orthopaedic surgery under general anesthesia, which estimated blood loss was800 ~ 1 500 mL. The target HCT concentration after acute normovolemic hemodilution（ANH） was 30%. Anesthesia was maintained with Remifentanyl and Sevoflane by adjusting mean blood pressure between 70 ～ 80mmHg. Blood loss during operation was recollected by recycling machine. To test a thrombelastogram after ANH and transfusion. HB, HCT, PLT, PT, APTT, TT and FIB were recorded before surgery, after ANH,transfusion, 1 day, 2 day, 3 day after surgery respectively. 【Results】 HB and HCT were significantly reduced after ANH. Compared with group ANH-after, no difference was found in HB and HCT between other groups.Thrombelastogram seem to be normal, and R was shorted after transfusion. Coagulation parameters were normal. 【Conclusion】 Combined autologous techniques not only reduce the infusion of allogeneic blood products,but also does not affect intraoperative and postoperative coagulation function.

关 键 词：自体血回输 等容性血液稀释 控制性降压 术中血液回收 

分 类 号：R614.1[医药卫生—麻醉学]