不同程度急性高容量血液稀释对老年病人凝血功能和全身炎性反应的作用

目的:探讨不同程度的急性高容量血液稀释对老年病人凝血功能和全身炎性反应的作用。方法:回顾性分析进行急性高容量血液稀释操作的老年病人156例的临床资料，根据稀释程度不同分为红细胞比容30%组（A组）和红细胞比容25%组（B组），比较术前（T₀）、血液稀释后（T₁）和手术结束时（T₂）2组病人的凝血功能和全身炎性反应情况。结果:2组病人T₂时的血红蛋白和血小板计数均较T₀明显降低（P<0.01），T₁时凝血酶原时间均高于T₀和T₂（P<0.05~P<0.01）。B组T₂时血红蛋白明显低于A组（P<0.01），T₁和T₂时血小板计数均明显低于A组（P<0.01）；2组各时点的凝血酶原时间、活化部分凝血活酶时间差异均无统计学意义（P>0.05）。2组病人T₁和T₂时的白细胞介素（IL）-1β、IL-6和心房利钠多肽水平均高于T₀（P<0.05~P<0.01），而肺顺应性均低于T₀（P<0.05~P<0.01）。B组T₁和T₂时IL-1β和肺顺应性水平均明显低于A组（P<0.01），T₂时心房利钠多肽水平高于A组（P<0.05）。结论:不同程度的急性高容量血液稀释对老年病人的凝血功能和全身炎性反应影响不同，较低程度的稀释可能会对病人内脏氧合造成影响，降低凝血功能，使全身炎性反应加重。

Effect of different degrees of acute hypervolumic hemodilution on the blood coagulation function and systemic inflammatory response in elderly patients

Objective:To explore the effects of different degrees of acute hypervolumic hemodilution on the blood coagulation function and systemic inflammatory response in elderly patients.Methods:The clinical data of 156 patients treated with acute hypervolumic hemodilution were retrospectively analyzed.According to the different degree of dilution,the patients were divided into the 30％Hct group(group A)and 25％Hct group(group B).The blood coagulation function and systemic inflammatory reaction between two groups before operation(T0),after operation(T1)and at the end of operation(T2)were compared.Results:The hemoglobin level and platelet count in two groups at T2 significantly decreased compared with at T0(P<0.01),and the prothrombin time in two groups at T1was significantly higher than that at T0 and T2(P<0.05 to P<0.01).The hemoglobin level in group B at T2 was significantly lower than that in group A(P<0.01),and the platelet count in group B at T1and T2 were significantly lower than that in group A(P<0.01).The differences of prothrombin time and activated partial thromboplastin time between two groups at all time-points were not statistically significant(P>0.05).The levels of interleukin(IL)IL-1β,IL-6,atrial natriuretic polypeptide(ANP)in two groups at T1 and T2 were significantly higher than those at T0(P<0.05 to P<0.01),and the pulmonary compliance(CL)at T1 and T2 were significantly lower than that at T0(P<0.01).The levels of IL-1β and CL in group B at T1and T2were significantly lower than those in group A(P<0.01),and the level of ANP in group B at T2 was higher than that in group A(P<0.05).Conclusions:The effects of different degrees of acute hypervolumic hemodilution on the blood coagulation function and systemic inflammatory response in elderly patients are different.The low degree of dilution may affect the oxygenation,reduce the blood coagulation function,and aggravate the systemic inflammatory response.