骨科手术患者急性高容量血液稀释-止血药-自体血回收联合应用的血液保护效果

目的 评价骨科手术患者急性高容量血液稀释(AHH)-止血药-自体血回收(IOBS)的血液保护效果.方法 择期骨科手术患者120例,性别不限,年龄18～64岁,ASA Ⅰ或Ⅱ级,预计术中出血量>800 ml,随机分为4组(n=30):AHH-IOBS-止血药组、IOBS-止血药组、 IOBS组和AHH-止血药组.AHH:气管插管后即刻至切皮前即刻,静脉输注6%羟乙基淀粉130/0.4溶液15 ml/kg,速率40 ml/min;IOBS:切皮前即刻行血液回收,血液洗出后即刻回输;止血药:切皮前10 min静脉注射血凝酶2 kU,同时肌肉注射1 kU.记录术中液体出入量、心率(HR)、平均动脉压(MAP)和中心静脉压(CVP),并采集静脉血样检测下列指标:血红蛋白浓度(Hb)、红细胞压积(Hct)、血小板计数(Plt)、凝血酶原时间(PT)、活化部分凝血酶原时间(APTT)和纤维蛋白原浓度(Fib).结果 与AHH-IOBS-止血药组比较,IOBS-止血药组CVP降低,Hb、Hct、Plt和Fib升高,AHH-IOBS组术中出血量增多,AHH-止血药组异体输血量增多和新鲜冰冻血浆使用免除率和异体输血免除率降低(P<0.05或0.01).结论 骨科手术患者AHH-IOBS-止血-联合应用的血液保护效应较好,安全性高.

Blood-saving efficacy of acute hypervolemic hemodilution-hemostatics-intraoperative blood salvage in patients undergoing orthopedic surgery

Objective To evaluate the blood-saving efficacy of acute hypervolemic hemodilution (AHH)-hemostatics-intraoperative blood salvage (IOBS) in patients undergoing orthopedic surgery. Methods One hundred and twenty ASA Ⅰ or Ⅱ patients of both sexes, aged 18-64 yr, scheduled for elective orthopedic surgery under general anesthesia with an expected blood loss of 800 ml or more, were randomly divided into 4 groups ( n = 30 each) : AHH + IOBS + hemostatics group; IOBS + hemostatics group; AHH + IOBS group; AHH + bemostatics group. AHH was induced with 6% hydroxyethyl starch 130/0.4 15 ml/kg infused iv at a rate of 40 ml/min immediately after tracheal intubation until the time of immediately before skin incision, IOBS was performed immediately before skin incision. Intravenous hemocoagulase 2 kU and im hemocoagulase 1 kU were injected 10 min before skin incision. The total volume of fluid intake and output, HR, MAP and CVP were recorded during the operation. Vein blood samples were taken for determination of Hb, Hct, platelet counts (Plt), prothrombin time (PT), activated partial thromboplastin time (APTT), and fibrinogen concentration (Fib) .Results CVP was significantly lower in IOBS+ hemostatics group than in AHH + IOBS + hemestaties group ( P < 0.05), while no significant difference in CVP was found between AHH + IOBS and AHH + IOBS + hemostatics group and between AHH + hemostatics and AHH +IOBS + hemostaties group (P > 0.05). The volume of blood loss was significantly higher in AHH + IOBS group, and the allogenic blood transfusion volume was significantly higher, while the percentage of the patients without allogeneie blood transfusion and without FFP transfusion lower in AHH + hemostatics group than in AHH + IOBS + hemostatics group ( P < 0.05 or 0.01 ), but there were no significant differences in the above parameters between IOBS + hemostatics group and AHH + IOBS + hemostatics group ( P > 0.05). Hb, Hct, Plt and Fib were significantly higher in IOBS + hemostatics group than in AHH + IOBS + hemostafics group( P < 0.05), but there were no significant differences in the above parameters between AHH + IOBS and AHH +IOBS + hemostatics group and between AHH + hemostatics and AHH + IOBS + hemestatlcs group (P > 0.05 ). Conclusion The blood-saving efficacy of AHH-bemostatics-IOBS is good in patients undergoing orthopedic surgery and it is a safe technique.