急性等容血液稀释自体血回输在重大手术中的应用

目的探讨重大手术出血量较大患者实施急性等容血稀释自体血回输(acute normovolemic hemodilution+autologous blood transfusion,ANH+ABT)的安全性和实用性。方法 400例ASAⅠ～Ⅱ级,自愿接受自体血回输的重大手术患者气管插管全身麻醉后,根据公式计算放血量,经中心静脉或动脉采集自体血,同时静脉输近似等量液体,维持患者心率、平均动脉压、中心静脉压基本稳定。采集的自体血于6小时内回输患者。于采血前(T0)、采血稀释后30分钟(T1)、回输自体血前(T2)、回输自体血后30分钟(T3)监测红细胞比容(Hct)、凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)及血小板计数(Plt)。结果 ANH+ABT实施期间患者血流动力学基本维持稳定,平均采血量(804.6±312.3)ml,平均出血量(1045.3±424.5)ml。术后短期随访未见ANH+ABT相关并发症。以T0为基础值,Hct在T1、T2显著下降(P0.05),PT、APTT在T1、T2较T0的绝对值高,但差异无统计学意义(P0.05),Plt计数在T1、T2、T3各时点均较T0明显下降(P0.05)。结论 ANH+ABT技术是一种有效、安全的血液保护策略。

Application of acute normovolemic hemodilution by autologous blood transfusion during major surgery

Objective To investigate the efficacy and safety of acute normovolemic blood hemodilution （ANH） plus autologous blood transfusion （ABT） for massive blood loss.Methods A total of 400 patients,in ASA class Ⅰ~Ⅱ,underwent a standard ANH plus ABT method and general anesthesia.After that,we removed blood from patients＇ artery or central vein with the volume according to formula V=EBV×（Hcto-Hctf）/Hctav,simultaneously replaced it with an appropriate volume of infusion and maintained heart rate,mean arterial pressure and central venous pressure stably.Collected autologous blood was transfused to patients within 6 hours.Values of Hct,PT,APTT,PLT,HR,MAP and CVP were measured and recorded before ANH （T0）,30 min （T1） after ANH,before ABT （T2） and 30 min after ABT （T3）.Results Hemodynamics of patients maintained stable during ANH plus ABT.Average blood volume collected from patients was （804.6±312.3）ml.Average blood loss volume was （1045.3±424.5）ml.No short-term ANH and ABT-related complications were observed.Hct decreased significantly at T1 and T2 （P0.05）.The absolute value of PT and APTT were higher at T1 and T2 than that at T0.Difference was not significant （P0.05）.Plt count decreased statistically at T1,T2 and T3 （P0.05）.Conclusion ANH plus ABT technique is an effective and safe blood conservation strategy.