急性等容血液稀释的有效性分析

随着对输异体血带来的并发症认识的加深 ,人们对于手术中不输血或少输血的要求越来越强烈 ,自体输血也因而在临床上得到广泛的研究和应用。其中 ,急性等容血液稀释(ＡＮＨ)在临床上的研究和应用较多 ,本文拟从数学模型上对其有效性作一分析。方法我们用图 1的模型来表示手术中失血和输异体血的关系。Ｘ表示患者手术失血量 ,Ｙ表示术中输异体血量 ,ＥＢＶ表示患者血容量。我们假定在整个手术过程中 ,患者的总血容量是保持不变的。Ｈ0 表示患者初始的血球压积 ,我们假设异体血的Ｈｃｔ也等于Ｈ0 。Ｈ1则表示患者在术中所允许达到的最低血球压…     

急性等容血液稀释在髋关节大手术中应用100例总结

髋关节手术创伤大、失血量多,尽管手术成功,但因输血而感染病毒性肝炎等疾病时有发生,又需耗费更多的财力来治疗,且收效甚微。因此,把血液稀释推广到骨科大手术中有十分重要的临床意义。资料及方法病例选择及麻醉方法　自愿接受自体输血治疗病人100例,其中男81例,女19例,年龄17～54岁。体重46～80kg。术前循环、呼吸、肝肾、凝血功能良好,ASA级。全组病人术前血红蛋白(Hb)≥125g·L-1,红细胞比容(Hct)≥35%,白蛋白≥35g·L-1。手术种类有:股骨头无菌坏死病灶清除,股骨大转子代股骨头、血管束植入,强直性脊椎炎,髋关节骨性关节炎病灶清除,…     

急性等容血液稀释结合抑肽酶用于髋关节手术病人的临床观察

减少手术出血和库血用量日益为麻醉医师所关注。本文对急性等容血液稀释（ＡＩＶＨ）结合抑肽酶（壹枚泰,兰州大得利生物化学制药厂生产）用于髋关节大手术,井和氨甲苯酸（ＰＡＭＢＡ）进行比较,了解手术出血量、输血补液量,以及围术期ＨＣＴ、Ｈｂ、ＰＬＴ和凝血功能的变化。资料与方法病例选择及麻醉方法 志愿接受自身输血治疗的骸关节大手术（股骨头无菌性坏死、骨性关节炎行病灶清除、肌骨瓣代股骨头,髓臼再造、加盖,血管束植入术。）病人６０例,其中男４２例,女１８例,年龄１８～５２岁,体重５０～７４ｋｇ,术前无各系统性…     

贺斯急性等容血液稀释对手术病人组织器官的影响

6 %贺斯是一种中分子量低取代级的羟乙基淀粉溶液 ,具有 4～ 8ｈ的循环稳定效应和血液流变学的优化效果。本实验的目的是观察 6 %贺斯对颅内占位手术病人实施急性等容血液稀释 ,病人血流动力学、氧供、氧耗、动脉血乳酸浓度、胸腔内血容量、血管外肺水和中心静脉氧饱和度等指标的变化 ,以降低各类手术对异体血液或血液制品的需求。资料和方法病例选择　选择 12例ＡＳＡⅠ～Ⅱ级颅内占位手术病人 ,其中脑膜瘤切除术 8例 ,垂体瘤切除术 2例 ,动脉瘤夹闭术 2例。男性 8例 ,女性 4例。年龄(47 8± 12 3)岁 ,体重 (6 8 7± 11 9)ｋｇ ,术前血红…     

急性等容血液稀释加控制性降压的临床观察

为减少手术出血和避免输入异体血 ,我院自 1 999年开始对部分骨科手术病人施行急性血液稀释加控制性降压措施 ,效果满意 ,报告如下。资料与方法一般资料　选择拟行脊椎及全髋关节置换术志愿者 6 0例 ,均男性 ,年龄 2 5～ 4 5岁 ,体重 5 0～ 6 5kg ,ASAⅠ级。无高血压病史 ,血红蛋白 (Hb) >1 1 0 g/L ,红细胞压积 (Hct) >0 35。随机分为两组 ,每组 30例。两组年龄、性别、手术方式均无差异。Ⅰ组 ,选择上肢静脉放血 ,经另一上肢静脉输入与放血量等量的 6 %羟乙基淀粉和复方乳酸钠 ,一般以复方乳酸钠 :6 %羟乙基淀粉 =3∶1 ,速度 8ml·kg …     

成人非心脏手术急性等容血液稀释时氧代谢变化

目的探讨成人非心脏手术急性等容血液稀释(acute normovolemic hemodilution,ANHD)时氧代谢的变化。方法对24例成人非心脏手术患者施行中度ANHD,观察术中ANHD开始时(T0)、ANHD进行中Hb浓度最低时(T1)及手术结束时(T2)氧代谢的指标。结果与T0比较,术中T1时红细胞比容和血红蛋白明显降低(P<0.05);虽然T1时静脉血氧饱和度、动脉血氧浓度、混合静脉血氧浓度、单位组织供氧量明显下降(P<0.05),但动脉氧饱和度、动脉血氧分压、混合静脉血氧分压、动-静脉氧浓度差和单位组织耗氧量并无明显改变,且手术结束后各指标与ANHD之前比较均无差异。结论中度ANHD对组织氧合的影响并不显著,对成人非心脏手术患者是安全的。     

急性等容血液稀释结合控制性降压用于髋关节手术的临床研究

急性等容血液稀释（ANHD）合并控制性降压（CH）有可能进一步减少手术出血量,但在人体安全性方面研究的报道较少。因此,在前期研究[1]的基础上将ANHD＆CH技术同时用于髋关节大手术,观察术中出血量、输血补液量、血气、氧供需平衡的变化。     

急性等容血液稀释联合低中心静脉压在肝癌手术中的应用

目的探讨急性等容血液稀释(ANH)联合低中心静脉压(LCVP)在肝癌手术中的应用价值及安全性。方法拟行右肝癌手术患者66例,ASAⅠ或Ⅱ级,年龄15～65岁,随机均分为三组,ANH+LCVP组、LCVP组和ANH组。患者全麻后行ANH,ANH+LCVP组和LCVP组在肝实质离断过程中将CVP控制在0～5cm H2O,肝实质离断止血彻底后将CVP恢复到7～8cm H2O;ANH组患者在整个手术过程中维持正常的CVP。记录三组患者肝实质离断时间、肝门阻断时间、肝实质横切面积、出血量,记录手术过程中患者的输血量、输液量、尿量以及三组患者术后第1、4、7天ALT、AST、TBIL、BUN和Cr值。结果 ANH+LCVP组和LCVP组肝门阻断时间、肝实质离断时间均明显短于ANH组(P<0.05),在肝实质离断过程中ANH+LCVP组和LCVP组MAP较术前和ANH组明显下降,HR较术前和ANH组明显增快(P<0.05)。肝实质离断过程中ANH组出血量和单位横截面积出血量均明显多于ANH+LCVP组和LCVP组(P<0.05)。ANH组未输异体血液比例明显低于ANH+LCVP组和LCVP组(P<0.05)。三组患者术毕Hb值均明显低于术前(P<0.05),术后第1、4、7天三组ALT、AST均明显高于术前(P<0.05)。结论在肝癌手术中联合应用急性等容血液稀释和低中心静脉压技术,可减少手术中异体输血,且对肝肾功能无明显影响。     

急性等容血液稀释结合术中自体血回输在脊柱手术中的应用

目的 探讨急性等容血液稀释结合术中自体血回输在脊柱手术中临床应用的可行性。方法 38例腰椎滑脱行后路减压、椎弓根螺钉内固定加椎体间Cage融合术患者,随机分为三组,急性等容血液稀释结合术中自体血回输组(组Ⅰ,n=12);自体血回输组(组Ⅱ,n=12);对照组(组Ⅲ,n=14)。术中均采用控制性低血压,记录术前、术中、回输前、回输后、术后的血红蛋白和红细胞比容,分别记录回输的血量和输异体血量。结果 急性等容血液稀释结合术中自体血回输组术中输异体血量约100ml,自体血回输组输异体血量约400ml,对照组输异体血量约800ml,经统计学检验有显著差异(P<0.05)。结论急性等容血液稀释结合术中自体血回输在脊柱手术中临床应用是一种安全有效、节约血源的方法,可减少异体血输入,避免其并发症。     

急性等容血液稀释在人工关节置换术中的应用

目的评价急性等容血液稀释在人工关节置换术围手术期的治疗效果以及异体血节约程度。方法回顾分析120例初次单侧人工关节置换术患者,对照组60例未进行自体血回输,实验组60例实施自体血回输,对比两组术前以及术后第2天的血红蛋白（Hb）、红细胞压积（Hct）、白蛋白（Alb）水平和术后2 d内录输注红细胞悬液和新鲜冰冻血浆的剂量。结果实验组与对照组在年龄、性别、手术类型间无统计学差异（t年龄=2.123,t性别=2.208,t手术类型=0.138,P均大于0.05）。实验组与对照组的术后Hb、术后Hct、术前Alb间无统计学差异（t术后Hb=-0.233,t术后Hct=0.310,t术前Alb=-1.698,P均大于0.05）。实验组术前Hb（140.58±13.92）g/L、术前Hct（40.43±3.83）高于对照组术前Hb（132.15±14.50）g/L、Hct（37.97±6.19）（t术前Hb=-3.251,t术前Hct=-2.626,P均小于0.05）。实验组术后Alb水平（32.70±2.05）g/L略低于对照组（33.80±3.11）g/L（t术前Alb=-1.698,t术后Alb=2.188,P均小于0.05）。实验组围手术期人均红细胞悬液和新鲜冰冻血浆使用量分别较对照组减少1.77 IU和2.45 IU（P〈0.001）。结论急性等容血液稀释自体血回输治疗在人工关节置换围手术期能够显著降低异体红细胞悬液和新鲜冰冻血浆的用量,同时不影响术后Hb以及Hct的水平。     

Endocrine reactions during acute normovolemic hemodilution

To investigate the influence of acute normovolemic hemodilution (ANH) on endocrine parameters in orthopedic surgery patients, 20 patients scheduled for total prosthetic replacement of the hip under epidural anesthesia with bupivacaine 0.5% were randomly allocated to the following groups: ANH group, (about 7.5 ml/kg body weight within 30 min) during substitution with 6% HES 200/0.5; Control group (without hemodilution). During a period before the onset of anesthesia and on the 1st day after the operation, MAP, HR, plasma concentrations of adrenaline and noradrenaline (by HPLC/ECD), and of ADH, ACTH and cortisol (by RIA) were determined at 8 points, as were glucose, lactate and free glycerol. Biometric data were comparable between the groups. MAP was significantly higher in the ANH group, and the intraoperative decrease was less pronounced. Adrenaline, ACTH, and cortisol revealed no specific influence of ANH and remained within the normal range in both groups. Noradrenaline was above the normal range in both groups and increased slightly (about 20%) during ANH. ADH was significantly higher in the control group. No specific influence of ANH was found with respect to glucose, lactate and free glycerol. In conclusion, ANH had no negative effects on the endocrine stress response during orthopedic surgery under epidural anesthesia. Sympatho-adrenergic reactions were only moderate and tolerable, even for patients with compensated cardiovascular disorders. Slight increases in endocrine parameters in the perioperative period documented adequate stress protection with epidural anesthesia.     

急性等容性血液稀释与凝血状态

目的 观察急性等容性血液稀释后凝血状态的变化。方法 20例择期手术病人随机分为两组,分别用羟乙基淀粉（HES）及琥珀明胶（GEL）进行血液稀释。血液稀释前、后15min测定血常规、传统凝血实验以及TEG指标。结果 血液稀释后,两组Hb及Hct均显著减少,Plt在GEL组显著减少;两组PT均显著延长,APTT无显著变化,FIB在GEL组显著减少;两组R、K值均显著缩短,ANG均显著增大,MA及A60则无显著变化。结论 中等程度的血液稀释不仅不会造成凝血障碍,反而使机体处于高凝状态。     

急性等容血液稀释在外伤性颅内血肿患者的应用

目的探讨对外伤性颅内血肿患者实施急性等容血液稀释的操作方法及有效性。方法56例外伤性颅内血肿患者随机分为两组,对照组（C组,n=28）、血液稀释组（H组,n=28）。H组于术前即刻行等容血液稀释,目标红细胞压积（Hct）为30％。于术前（To）、手术开始后2小时（T1）分别抽取静脉血测血液流变学指标。结果To时,两组血液流变学指标相似,差异无统计学意义。T-时C组明显升高,两组间相比差异有统计学意义（P〈0．05）。结论颅脑外伤后,血液流变学指标升高,急性等容血液稀释（Hct=30％）可以降低血液黏度,改善脑挫伤后脑组织氧代谢紊乱,发挥一定的脑保护作用。     

Beneficial effect of acute normovolemic hemodilution in cardiovascular surgery

OBJECTIVE: The efficacy of acute normovolemic hemodilution (ANH) in avoiding homologous blood transfusion (HBT) during cardiovascular surgery remains controversial. Our objective was to evaluate the impact of ANH on blood transfusion requirements during open cardiovascular surgery using cardiopulmonary bypass (CPB). METHODS: We retrospectively reviewed 243 patients who had undergone open cardiac or thoracic aortic surgery using CPB between September 2001 and July 2003 in our department. ANH was performed when the hematocrit was over 35% and the patient was hemodynamically stable. Risk factors were selected in accordance with the Japanese Adult Cardiovascular Surgery Database and analyzed to determine their effect on perioperative HBT requirement. RESULTS: Of the 243 patients, 64 (26%) underwent preoperative autologous blood donation and 62 (26%) ANH. HBT was required in 62% of patients (150/243) overall, in 32% (20/62) of ANH patients, and in 76% (130/171) of non-ANH patients. Multivariate stepwise logistic regression analysis revealed that preoperative or pre-donation hemoglobin value (p < 0.001), duration of surgery (p = 0.001), intraoperative minimum rectal temperature (p = 0.001), age (p = 0.002), need for emergency surgery (p = 0.003), amount of ANH (p = 0.018), blood loss (p = 0.033) and amount of preoperative autologous blood donation (p = 0.042) were independent predictors of the need for perioperative HBT. CONCLUSIONS: Our data showed that open cardiovascular surgery using CPB continues to pose a high risk of HBT, but that ANH is an effective means of reducing this risk in those patients undergoing these operations.     

Beneficial effect of acute normovolemic hemodilution in cardiovascular surgery

Objective: The efficacy of acute normovolemic hemodilution (ANH) in avoiding homologous blood transfusion (HBT) during cardiovascular surgery remains controversial. Our objective was to evaluate the impact of ANH on blood transfusion requirements during open cardiovascular surgery using cardiopulmonary bypass (CPB). Methods: We retrospectively reviewed 243 patients who had undergone open cardiac or thoracic aortic surgery using CPB between September 2001 and July 2003 in our department. ANH was performed when the hematocrit was over 35% and the patient was hemodynamically stable. Risk factors were selected in accordance with the Japanese Adult Cardiovascular Surgery Database and analyzed to determine their effect on perioperative HBT requirement. Results: Of the 243 patients, 64 (26%) underwent preoperative autologous blood donation and 62 (26%) ANH. HBT was required in 62% of patients (150/243) overall, in 32% (20/62) of ANH patients, and in 76% (130/171) of non-ANH patients. Multivariate stepwise logistic regression analysis revealed that preoperative or pre-donation hemoglobin value (p<0.001), duration of surgery (p=0.001), intraoperative minimum rectal temperature (p=0.001), age (p=0.002), need for emergency surgery (p=0.003), amount of ANH (p=0.018), blood loss (p=0.033) and amount of preoperative autologous blood donation (p=0.042) were independent predictors of the need for perioperative HBT. Conclusions: Our data showed that open cardiovascular surgery using CPB continues to pose a high risk of HBT, but that ANH is an effective means of reducing this risk in those patients undergoing these operations.     

急性等容血液稀释血液保护的Meta分析

目的 急性等容血液稀释（ANH）血液保护的Meta分析。方法 以ANH为关键词检索Medline、EMBase、Cocarane图书馆对照试验注册资料库、中国生物医学数据库、中国医学会议论文数据库，结合检索论文中的参考文献查询相关文献，文献检索至2005年12月。选择成人择期手术中应用ANH的随机对照试验，收集试验组及对照组病人资料进行Meta分析。结果 检索到符合条件的文献31篇，包含病例数1582例（试验组／对照组783／799），共纳入32项研究，Jadad’s评分为1分。对纳入研究进行整体分析显示，ANH能减少输血量、输血率，对出血量无影响，输血量、出血量的加权均数差分别为-1．41U[95％可信区间（95％CI）为-1．82～-1．01U]、-75．43ml（95％CI为-219．46～68．60ml）（P〈0．05），输血率比数比（OR）为0．14（95％CI为0．07—0．29），各研究间均存在异质性（P〈0．1）。按手术种类、血液稀释程度及有无明确输血指征进行亚组分析结果与整体分析时基本一致。有6项研究报告了并发症情况，不良事件总发生率的OR为0．68（95％CI为0．34—1．36）。结论 ANH能减少输血量和输血率，但不减少出血量。