急性高容量血液稀释联合自体血回输在老年全髋关节置换术患者中的应用研究  

Application of acute hypervolemic hemodilution combined with intraoperative autologous blood transfusion in total hip replacement for elderly patients

作　　者：朱丹艳 吴啸鸽 郭小云 彭文勇 金卫东 蓝志坚 陈元良 ZHU Danyan;WU Xiaoge;GUO Xiaoyun;PENG Wenyong;JIN Weidong;LAN Zhijian;CHEN Yuanliang(Department of Anesthesiology,the Affiliated Jinhua Hospital,Zhejiang University School of Medicine(Jinhua Municipal Central Hospital),Jinhua 321000,China;不详)

机构地区：[1]浙江大学医学院附属金华医院(金华市中心医院)麻醉科,321000 [2]金华市妇幼保健院麻醉科

出　　处：《浙江医学》2023年第14期1474-1478,共5页Zhejiang Medical Journal

基　　金：金华市科学技术局公益类项目(2021-4-095)。

摘　　要：目的探索急性高容量血液稀释联合术中自体血回输技术对老年全髋关节置换术患者血液保护功能和凝血功能的影响。方法选取2021年6月至2023年3月金华市中心医院择期行全髋关节置换术患者100例,采用随机数字表法分为研究组和对照组,每组50例。两组均采用全麻,研究组在手术开始前0.5 h从颈内静脉快速输入15 mL/kg的乳酸钠林格注射液和羟乙基淀粉130/0.4电解质注射液(1∶1)进行急性高容量血液稀释,对照组常规速度输注乳酸钠林格注射液,两组患者术中均行自体血回输。分别于入手术室(T_(0))、手术结束(自体血回输已完成,T_(1))、术后24 h(T_(2))检测Hb及行血栓弹力图检测评估凝血功能,统计T_(1)、T_(2)Hb较T_(0)Hb下降值,记录术中出血量、术中术后是否有输注异体血,并于术后3、7及30 d随访患者,记录肺栓塞发生率。结果两组患者术中出血量比较差异无统计学意义(P>0.05)。在T_(1)、T_(2)Hb较T_(0)Hb下降值方面,研究组较对照组均明显减少,差异均有统计学意义(均P<0.05)。在异体血输注比例方面,研究组较对照组明显减少,差异有统计学意义(P<0.05)。两组患者在血栓弹力图检测的凝血功能方面及术后肺栓塞发生率比较差异均无统计学意义(均P>0.05)。结论急性高容量血液稀释联合术中自体血回输技术对老年全髋关节置换术患者有血液保护作用,减少围术期异体输血,不影响凝血功能且不增加术后肺栓塞发生率,具有重要的临床意义。Objective To investigate the effect of acute hypervolemic hemodilution combined with intraoperative autologous blood transfusion on blood coagulation function in elderly patients undergoing total hip replacement.Methods One hundred patients who underwent elective total hip replacement in Jinhua Municipal Central Hospital from June 2021 to March 2023 were randomly divided into two groups with 50 cases in each group.The study group received a rapid infusion of 15 mL/kg of sodium lactate Ringer's injection with hydroxyethyl starch 130/0.4 and electrolyte injection(1∶1)through the internal jugular vein within 30 min before surgery.The control group received a conventional infusion of sodium lactate Ringer's injection.Both groups received intraoperative autologous blood transfusion.Hemoglobin and thromboelastoghy were measured at the time of entry into the operating room(T_(0)),end of surgery(autologous blood transfusion completed,T_(1))and 24 h after surgery(T_(2)).The reduction of hemoglobin at T_(1) and T_(2) from T_(0) was calculated.The volumes of intraoperative bleeding and allogeneic blood transfused during and after the surgery were documented.Patients were followed up 3,7 and 30 d after surgery and the incidence of pulmonary embolism was observed.Results There was no significant difference in bleeding volume between two groups(P>0.05).Compared with the control group,the reduction of hemoglobin at T_(1) and T_(2) from T_(0) in the study group was less(both P<0.05).Compared with the control group,the proportion of patients with allogeneic blood transfusion in the study group was lower(P<0.05).There was no significant difference in the abnormal rate of thromboelastoghy between two groups(P>0.05).There was no significant difference in the incidence of pulmonary embolism between two groups(P>0.05).Conclusion The combination of acute hypervolemic hemodilution and intraoperative autologous blood transfusion can reduce perioperative blood loss and allogeneic blood transfusion,does not affect coagulation function an

关 键 词：急性高容量血液稀释 自体血回输 全髋关节置换术 血栓弹力图 肺栓塞 

分 类 号：R614[医药卫生—麻醉学]