自体输血对心脏瓣膜置换手术病人血液学、血液动力学及氧合状况的影响  

THE EFFECT OF AUTOTRANSFUSION ON HEMATOLOGY,HEMODYNAMICS AND OXYGENATION IN THE HEART VALVE REPLACEMENT PATIENTS

作　　者：詹鸿[1] 黄焕娟[1] 陶红斌[1] 张秀燕[1] 谭灿辉[1] 陈浩文[1] 苏志源[1] 

机构地区：[1]广州医学院附属市二医院麻醉科,510150

出　　处：《中国现代医学杂志》2002年第14期1-3,共3页China Journal of Modern Medicine

基　　金：广东省医学科研基金资助 (课题编号A2 0 0 0 5 67)

摘　　要：目的 :观察自体输血对心瓣膜置换术病人血液学、血液动力学及氧合状况的影响。方法 :2 0例心瓣膜置换术病人 ,心功能Ⅱ～Ⅲ级 ,年龄 2 5～ 5 7岁 ,用芬太尼、咪唑安定、维库溴铵麻醉诱导 ,并以芬太尼、维库溴铵、吸入异氟醚维持麻醉。体外循环用乳酸林格氏液及血定安或血浆作预充液 ,使血液达中等稀释程度 ,并用血液回收机回收术野及体外循环机器管道内剩余血 ,术毕经处理后回输给病人。观测自体输血前后血液学、血液动力学及氧合的变化。结果 :心脏复跳后RBC ,HB ,HCT ,PLT明显降低 ,凝血酶原时间 (PT)和活化部分凝血酶原时间 (APTT)明显延长 ,PvO2 、SvO2 值明显升高 ,氧摄取率 (O2 ER)增高。术毕回输自体血后HB ,HCT明显回升 ,虽仍低于术前水平 ,但MAP ,CVP ,PCWP和CI维持稳定 ,混合静脉血氧分压 (PvO2 )和混合静脉血氧饱和度 (SvO2 )明显回升并在正常范围 ,O2 ER明显回降。结论 :中度血液稀释和回收式自体输血 ,术中应用于非重度瓣膜置换术病人 。Objective:To investigate the effect of autotransfusion on hemodynamics and oxygenation on patient with valve replacement surgery. Methods:20 cases of valve replacement patients, heart function Ⅱ～Ⅲ degree, age between 25～57 years. Fentanyl, midazolam and norcuronium were used for induction. Fentanyl, norcuronium and isofiurane were used to maintain anesthesia. Cardiopulmonary bypass(CPB) used Ringer's lacte solution, gelofusine or plasma to controll the blood hemodilution at medium range. Cell saver was used in the whole sequence of surgery, the recovered blood was infused at the end of surgery.Results:Values of RBC, HB, HCT, PLT were significantly decreaced, PT and APTT were significantly prolonged after the restoration of spontaneous heart beat. Values of PvO 2, SvO 2 and CI were significantly increased and O 2ER significantly decreased after the autologus transfusion.Conclusion:the technique of moderate hemodilution and cell saver for the surgical replacement of moderately severe valve disease was safe. No significant changes in oxygenation and coagulation were found.

关 键 词：心脏瓣膜置换手术 自体输血 心脏手术 血液学 血液动力学 氧代谢 

分 类 号：R654.2[医药卫生—外科学] R457.1[医药卫生—临床医学]