急性高容量血液稀释用于肝癌手术对凝血功能和血流动力学的影响

目的 观察和比较肝癌患者应用不同种类血浆代用品进行高容量血液稀释（AHHD）后凝血机制的变化.探讨AHHD用于肝癌的安全性和可行性,为临床合理应用代血浆提供实验依据.方法 择期肝癌患者45例,随机分为三组,乳酸钠林格（R）组,6%羟乙基淀粉W（Volven商品名：万汶）组、4%琥珀酰明胶G（Gelofusine）组,每组15例.于麻醉后手术前30min内快速输注15～20 ml/kg液体,同时测定诱导前（T0）,切皮前（T1）,手术开始后1h（T2）和手术结束10min（T3）的凝血功能和动脉血气分析.结果 AHHD后患者循环功能稳定,输血量减少,血细胞比容（HCT）降低明显,凝血功能降低,基本在正常范围.结论 应用血浆代用品进行AHHD能有效维持血液循环功能但静脉压会偏高,可以用血管扩张剂或加深麻醉缓解,对凝血功能有影响,PT（凝血酶原时间）、APTT（活化部分凝血活酶时间）延长,TT（凝血酶时间）、FIB（纤维蛋白原）数值降低,血小板计数降低,但基本在正常的范围内,不会增加术中出血,所以对肝癌患者施行AHHD,应严格掌握适应证并加强监测.

EFFECT OF ACUTE HYPERVOLEMIC HEMODILUTION ON FUNCTIONS OF COAGULATION IN LIVER - CANCER

Objective To observe and compare the change of coagulation in liver-cancer after using different fluid to make AHHD and to investigate its safety in clinical practice.Methods 45 patients were randomly divided into 3 groups with 15 patients in each group.In group V by Voluen,group G by 4%Gelofusine,group R by Ringer.Before operation the patients were infused in the amount 15-20mg/kg during 30 minutes.In the meantime,the functions of coagulation and blood gas analyze were tested before the modulation,after the modilution,1 hour after operation and 10 minutes over operation.Results After AHHD the cardiac function did not changed,the amount of blood loss was decrease.Hct decrease obviously,the coagulation function decrease but in normal level.Conclusion Applying artificial colloid plasma substitutes in peri-operation can effectively maintain the circulation stability,but can increase the CVP,It can effect the coagulation function,prothrombin time(PT),activated partial thromboplastin time(APTT),thrombin time(TT),fibrinogen(FiB),PLT decrease but in certain range.Don't increase the amount of blood loss,so we must be commended the patient in liver-cancer for AHHD.