术前急性高容量血液稀释对血液流变特性影响的临床研究

目的观察急性高容量血液稀释(AHH)后血液流变学特性的变化，为临床合理应用血浆代用品提供理论依据。方法90例髋关节手术患者随机分为三组，每组30例，按20ml/kg在手术开始前分别输注6％羟乙基淀粉、4％琥珀明胶或乳酸林格氏液扩容量，达到高容量血液稀释。检测稀释前后全血粘度、血浆粘度、Hct、红细胞聚集指数、红细胞变形指数。结果AHH后循环功能稳定，围手术期异体血输入量胶体液组明显少于晶体液组。AHH后全血粘度、Hot明显降低；红细胞聚集指数降低、细胞变形指数6％羟乙基淀粉组升高。结论术前AHH可以有效地雏持术中循环功能稳定，优化血液流变状态，利于微循环灌注，提高患者对失血的耐受性，减少异体输血量，肢体溶液优于晶体溶液。

The Effects of Acute Hypervolemic Hemodilution on Hemorheology

Objective To observe the changes of hemorheology after acute hypervolemic hemodilution (AHH), and provide theoretic basis for clinical rationally using artificial plasma substitutes. Methods 90 patients undergoing hip joint operation were randomly divided into 3 groups (each group containing 30 patients), which received intravenous infusion of 6% hydroxyethyl starch (HES), 4% gelofusine or ringer's solution at 20ml/kg, respectively before operation. The whole blood viscosity, plasma viscosity, Hct, index of RBC aggregation and index of RBC deformation were measured before and after hemodilution. Resutls Hemodynamics was stable after AHH, and the amounts of perioperatively blood transfusion in the patients received colloid solution were obviously less than those in the patients received crystalloid solution. The whole blood viscosity, Hct and index of RBC aggregation significantly decreased after AHH in all the patients, and index of RBC deformation markedly increased in the patients after AHH with 6% HES. Conclusion AHH could effectively maintain hemodynamics stable, improve hemorheological condition and perfusion of microcirculation, enhance the tolerance of blood loss, and reduce homologous blood transfusion. Colloid solution was better than crystalloid solution for AHH.