白眉蛇毒血凝酶预给药联合急性高容量血液稀释对肝癌手术患者凝血功能的影响及血液保护作用

目的观察白眉蛇毒血凝酶麻醉前预给药联合急性高容量血液稀释(AHHD)对肝癌手术患者凝血功能的影响及血液保护作用。方法选取2011年2月至2012年5月广西医科大学附属肿瘤医院择期全麻下行肝癌切除术患者90例,采用随机数字表法分为三组:A组(30例)麻醉前白眉蛇毒血凝酶预给药联合AHHD;B组(30例)麻醉前使用AHHD;C组(30例)麻醉前未使用白眉蛇毒血凝酶预给药和AHHD。三组患者分别于麻醉前(T0)、切皮时(T1)、肝门阻断前(T2)、肝门开放后(T3)、术毕(T4)各时间点观察凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、凝血酶时间(TT)、纤维蛋白原(Fib)、D-二聚体(DD)、血小板(PLT)、血红蛋白(Hb)、血细胞比容(Hct)等指标,术后记录所有患者的失血量、异体输血量及术后腹腔引流量。结果三组患者T0、T1、T2、T3、T4不同时点间的PT、APTT、TT、Fib、DD指标比较差异均无统计学意义(P>0.05)。三组患者T0、T1、T2、T3、T4不同时点间的Hb、Hct比较差异无统计学意义(P>0.05),组间比较差异有统计学意义(P<0.05)。A组患者的出血量、输血量、术后腹腔引流量及手术时间均少于B组和C组(P<0.05)。三组患者均未出现无肝昏迷、急性肾衰竭及肺栓塞等严重并发症。结论白眉蛇毒血凝酶预给药联合AHHD对凝血功能影响小,可减少术中出血量。

Effect of Hemocoagulase Pre-administration Combined with Acute High-volume Hemodilution on Coagulation Function and Blood Conservation in Patients of Liver Cancer under Surgery

Objective To observe the effect of hemocoagulase pre-administration combined with acute high-volume hemodilution（AHHD） on coagulation function and blood conservation in patients of liver cancer under surgery.Methods A total of 90 patients of general anesthesia underwent liver cancer resection in the Affiliated Tumor Hospital of Guangxi Medical University from Feb.2011 to May 2012 were randomly divided into three groups according to different blood conservation methods（group A：hemocoagulase pre-administration combined withd AHHD before operation;group B：AHHD before operation;group C：control group）,with 30 cases in each group.The indicators of PT,APTT,TT,Fib,DD,PLT and Hb,Hct were observed at pre-anesthesia（T0）,skin incision（T1）,hepatic portal clamping（T2）,after hepatic portal openning（T3）,surgery finished（T4）respectively.The amount of blood loss,allogeneic blood transfusion,and postoperative abdominal drainage was recorded after surgery.Results There were no statistically significant differences in the indexes of PT,APTT,TT,Fib,DD at T0,T1,T2,T3,T4 in the three groups（P ＞ 0.05）.There were no statistically significant differences in the indexes of Hb,Hct at T0,T1,T2,T3,T4 in the three groups（P ＞ 0.05）,although there were statistically significant differences between every two groups（P ＜ 0.05）.The amount of bleeding,blood transfusion,postoperative drainage and the operation time of group A was less than group B and group C（P ＜ 0.05）.There were no serious complications of hepatic coma,acute renal failure and pulmonary embolism occurred to the patients in all of the three groups.Conclusion Hemocoagulase pre-administration combined with AHHD has little effect on coagulation function and can reduce the amount of blood loss during operation.