术前急性高容量血液稀释对血液流变特性的影响

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、Hct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可以有效地维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，胶体溶液优于晶体溶液。

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 rational using artificial plasma substitutes. Methods: 90 hip joint operative patients were randomly divided into 3 groups (n=30) to receive intravenous infusion of 6% hydroxyethyl strach (HES), 4% gelofusine or Ringer's solution at 20 ml/kg 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 were stable after hemodilution, the amounts of blood transfusion perioperatively in the colloid group patients were less than that patients in the crystalloid group. The whole blood viscosity, Hct and index of RBC aggregation was significant reduced after AHH in all patients, index of RBC deformation was markedly increased on patients after AHH with 6% HES. Conclusion: AHH can effectively maintain hemodynamic stable, improve the hemorheological condition and perfusion of microcirculation, enhance the tolerance of blood loss, and reduce homologous blood transfusion. Colloid are better than crystalloid for AHH.