血液稀释联合自体血回输在老年患者中的应用  

Application of hemodilution combined with autogolous blood transfusion for aged patients

作　　者：张干[1] 梁大干 高涛[1] 虢新莲[1] 

机构地区：[1]深圳市宝安区人民医院麻醉科,广东深圳518101

出　　处：《现代医学》2016年第7期929-932,共4页Modern Medical Journal

基　　金：深圳市宝安区科技计划社会公益项目(2014044)

摘　　要：目的:探讨急性非等容血液稀释(ANIH)联合自体血回输在老年全髋置换术中应用的安全性及有效性。方法:将60例拟行全髋置换的老年患者随机分为ANIH联合自体血回输组(A组)和自体血回输组(B组),各30例。记录麻醉前(T_0)、全麻诱导5 min后(T_1)、血液稀释5 min后(T_2)、扩大股骨髓腔和清理髋臼后即刻(T_3)、回输自体血前(T_4)、术毕(T_5)各时点的有创平均动脉压(MAP)、中心静脉压(CVP)与心率(HR)。监测各组在T_0、T_2、T_3、T_4、T_5时点的血红蛋白(Hb)、红细胞比容(Hct)、凝血酶原时间(PT)、活化部分凝血酶原时间(APT_T_)。记录术中出血量、自体血回输量、异体输血量和异体输血例数及输血不良反应。结果:A组血液稀释后CVP显著增高(P<0.01),Hb及Hct显著下降(P<0.01),APTT显著延长(P<0.05)。与B组比较:在T_3时点,A组的CVP显著增高(P<0.05),Hb及Hct显著降低(P<0.05);在T_5时点,A组的Hb及Hct显著升高(P<0.05),异体输血量和异体输血例数显著下降(P<0.05)。结论:ANIH联合自体血回输应用于老年全髋置换术安全有效。Objective： To evaluate the safety and effectiveness of acute non-isovolemic hemodilution（ ANIH）combined with autogolous blood transfusion for aged patients undergoing total hip replacement. Methods： Sixty aged patients underwent total hip replacement were randomly divided into 2 groups（ 30 in each） ： ANIH combined with autogolous blood transfusion group（ group A） and autogolous blood transfusion group（ group B）. MAP,CVP and HR were recorded before anesthesia（ T0）,5 minutes after anesthesia induction（ T_1）,5 minutes after hemodilution（ T_2）,immediately after the expansion of the femoral medullary cavity and the cleaning of the acetabulum（ T_3）,before reinfusing the autogolous blood（ T_4） and at the end of the operation（ T5）. Hb,Hct,PT and APTT were detected at T_0,T_2,T_3,T_4,T_5. Record the volume of blood loss,autogolous blood,the volume and cases of allogenic blood transfusion,the adverse reaction of blood transfusion. Results： After hemodilution,CVP significantly increased（ P〈0. 01）,Hb and Hct significantly decreased（ P〈0. 01）,APTT prolonged markedly（ P〈0. 05） in group A. Compared with group B： at T_3,CVP significantly increased（ P〈0. 05）,Hb and Hct significantly decreased（ P〈0. 05） in group A; at T_5,Hb and Hct significantly increased（ P〈0. 05） in group A. The volume and cases of allogenic blood transfusion in group A significantly decreased（ P〈0. 05）. Conclusion： The application of ANIH combined with autogolous blood transfusion for aged patients underwent total hip replacement is safe and effective.

关 键 词：血液稀释 自体血回输 老年人 全髋置换术 

分 类 号：R457.1[医药卫生—治疗学]