急性高容量血液稀释对大肝癌切除术患者失血耐受性的影响

目的:探讨术前急性高容量血液稀释(AHH)对大肝癌切除术患者失血耐受性的影响.方法:择期行大肝癌切除术患者30例,随机分为A组和B组,硬膜外麻醉后全麻诱导前,A组快速输注6%羟乙基淀粉液15mL/kg,B组输注等量乳酸林格氏液.监测平均动脉压(MAP)、心率(HR)和中心静脉压(CVP),记录术中出血量、输血输液量;于稀释前、稀释后即刻、术毕及术后1d测定红细胞压积(Hct)、血红蛋白(Hb)和血乳酸(Lac).结果:两组出血量、输液量及各时段Lac无统计学差异,A组输血量明显低于B组;A组MAP较B组平稳;两组CVP稀释后均明显升高;A组Hct和Hb术毕术后1d明显低于基础值及C组.结论:大肝癌切除术患者术前行AHH,能有效维持血流动力学平稳,提高患者对失血的耐受性.

Effect of Acute Hypervolemic Hemodilution on Patient's Tolerance to Blood Loss during Huge Liver Cancer Resection

Objective: To investigate the effect of acute hypervolemic hemodilution(AHH) on patients' tolerance to blood loss during huge liver cancer resection. Methods: Thirty patients undergoing elective huge liver cancer resection were randomized into 2 groups:A and B.6% hydroxyethyl starch 15 mL/kg was infused in group A,while group B lactated Ringer's solution instead. MAP,HR and CVP were monitored;Hct and Hb were measured before and immediately after AHH, at the end of operation and at the 1 st day after operation. Results: Two groups were comparable with respect to demographic data, blood loss and the amount of fluid infused during operation. The volume of blood infused were significantly reduced in group A .MAP was more stable in group A than in group B. CVP was increased after infusion of HES in group A and lactated Ringer's solution in group B. Hct and Hb were lower at the end of operation and the 1st day after operation in group A. Lac did not change significantly. Conclusion: AHH before operation can increase patients' tolerance to blood loss during resection of huge liver cancer.