急性等容血液稀释对老年肝癌病人围手术期凝血功能的影响

目的探究急性等容血液稀释对老年肝癌病人围手术期凝血功能的影响。方法选取我院于2008年9月～2011年4月收治的老年肝癌患者90例，将其随机分组，观察组与对照组各45例，在肝癌切除术中分别接受急性等容血液稀释（ANH）及常规输液，观察两组患者术前及术后各时期血常规及凝血功能指标的变化情况。结果观察组术中出血量709．6±47．2ml，对照组为713．5±49．0ml，（P〉0．05）；观察组术中输血量342．9±29．6ml，对照组为463．5±39．4ml，观察组术中出血量明显低于对照组；两组患者术中Hb及Hct均降低，术后24h得到一定程度的恢复，观察组恢复程度优于对照组；两组患者术中、术毕及术后24h其PT及Fbg均存在明显改变，组间对比无明显统计学差异（P〉0．05）。术中观察组PLT明显高于对照组（P〈0．05）。两组患者各时期aPTT、TT、及D—D均无明显改变。结论急性等容血液稀释能够有效降低老年肝癌病人手术中输血量，是一种安全、可靠的节约用血、降低并发症的血液保护方案。

Effects of Acute Normovolemic Hemodilution on Blood Coagulation Function During the Operation in Elderly Patients with Hepatocellular Carcinoma

Objective To explore the effects of acute normovolemic hemodilution on blood coagulation function during operation period of elderly patients with hepatocellular carcinoma. Methods 90 cases with hepatoeellular carcinoma in our hospital in September 2008 - April 2011, the observation group and the control group with 45 cases in each group ,the liver resection received acute normovolemic hemodilution （ANH） and conventional infusion, observe the change of the during the two groups of patients with preoperative and postop- erative blood routine and blood coagulation indexes. Results the intraoperative blood loss in the observation group 709.6 ± 47.2 ml, the control group 713.5±49 ml, （ P 〉 0.05 ） ; to observe the blood transfusion group 342.9 ± 29.6 in ml, control group 463.5± 39.4 ml the amount of bleeding, observation group was significantly lower than the control group;Hb and Hct patients in the two groups were decreased after 24 h,recovered to a certain extent, the degree of recovery in observation group than the control group;patients in the two groups af- ter the operation, and postoperative 24 h PT and Fbg have obvious change, group in contrast no statistically sig- nificant difference （ P 〉 0.05 ）, were observed in group PLT was higher than that of control group （ P 〈 0. 05 ）. There was no obvious change in aPTT, TT, and D- D of two groups of patients in each period. Conclusion acute normovolemic hemodilution can effectively reduce the blood transfusion operation in elderly palients with HCC patients, is one kind of security, reliable blood conservation,reduce the complications of blood＂ pro- tection scheme.