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目的研究等容血液稀释自体输血(ANH)对肝癌手术患者围术期机体内环境和凝血功能的影响,探讨ANH的节血效果和安全性。方法选择肝癌手术患者40例,随机分为2组。等容血液稀释性自体输血组(I组):于麻醉后手术切皮前经桡动脉放血400~600 ml,同时经静脉输入相当容量的万汶血浆替代品,手术后半阶段将自体血回输。未做血液稀释组(II组):分别于麻醉诱导前(T1)、ANH后30 min及术始(T2)、输血后(T3)、术毕(T4)和术后24 h(T5)测定pH值、HCO3-、K+、Na+、PT、APTT、PLT和血浆蛋白。结果 II组有8例输异体血而I组只有2例,2组在输异体血后pH值和HCO3-下降较未输异体血者明显(P<0.05)。PT、APTT在各测定点2组变化一致,2组间均无显著性差异(P>0.05),I组PLT在T3后回升明显而II组继续下降。I和II 2组血浆蛋白在T2都下降明显(P<0.05),但I组在T3后回升。结论等容血液稀释自体输血(ANH)对肝癌手术患者的围术期机体内环境和凝血功能影响较小,节血效果明显,安全有效,更具优越性。
Objective To study the effect of isovolemic hemodilution autologous blood transfusion (ANH) on perioperative hypoxemia and coagulation in patients with hepatocellular carcinoma (HCC) and to investigate the effect and safety of ANH on blood loss. Methods Forty patients with hepatocellular carcinoma were randomly divided into two groups. Isotonic hemodilutive autologous blood transfusion group (group I): 400 ~ 600 ml transradial arterial bleeding before anesthetized operation skin incision, meanwhile, a considerable volume of Vancomycin plasma substitute was intravenously administered. After half-operation, lose. The rats in group A and group B were not subjected to hemodilution (group II): before induction of anesthesia (T1), 30 min after ANH and after operation (T2), after transfusion (T3) pH, HCO3-, K +, Na +, PT, APTT, PLT and plasma proteins. Results In group II, there were 8 cases of transfusion of blood and 2 cases of group I. The pH and HCO3-drop of group 2 were significantly lower than those of group without transfusion (P <0.05). The changes of PT and APTT were consistent between the two groups at each measurement point. There was no significant difference between the two groups (P> 0.05). The PLT of group I rose significantly after T3 and the group II continued to decline. Plasma protein in Group I and II 2 decreased significantly at T2 (P <0.05), but Group I rose at T3. CONCLUSION: Isotonic hemodilution autologous blood transfusion (ANH) has little effect on perioperative intra-body environment and blood coagulation in patients with liver cancer. The hemostatic effect is obvious, safe, effective and superior.