急性非等容血液稀释联合自体血回收应用于老年全髋关节置换术的临床观察
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摘要
目的:探讨急性非等容血液稀释(ANIH)联合术中自体血回收在老年全髋关节置换术中的应用效果及安全性。方法:92例老年髋关节置换患者随机分为对照组(术中自体血回收回输)和观察组(术中自体血回收回输+术前ANIH)各46例。记录麻醉前(T0)、麻醉后5min(T1)、ANIH后5min(T2)、髋臼清理即刻(T3)、自体血回输前(T4)、术毕(T5)的平均动脉压(MAP)、心率(HR)、中心静脉压(CVP)及血红蛋白(Hb)、血细胞比容(Hct)、凝血酶原时间(PT)、活化部分凝血酶原时间(APTT)。比较2组术中出血量、回输自体血量、异体血输注量、异体血输注例数及不良反应。测定自体回收血红细胞滤过指数(IF)、红细胞2,3二磷酸甘油酸(2,3-2DPG)含量及红细胞内Ca2+浓度。结果:观察组T2、T3时CVP较T1时升高(P<0.01),T3时CVP较对照组升高(P<0.05)。与T0时比较,观察组T2、T3时Hb、Hct下降(P<0.01),APTT延长(P<0.05);与对照组比较,观察组T3时Hb、Hct下降(P<0.05),T5时Hb、Hct升高(P<0.05)。观察组异体血输注量和异体血输注例数低于对照组(P<0.05)。与对照组比较,观察组自体回收血IF及Ca2+浓度降低(P<0.05),2,3-2DPG含量升高(P<0.05)。结论:ANIH联合术中自体血回收节血效果明显,对老年全髋置换患者血流动力学和凝血功能影响较小,回收血红细胞质量较高。
Objective:To evaluate the safety and effectiveness of acute non-isovolemic hemodilution(ANIH)combined with intraoperative autologous blood salvage for aged patients with total hip replacement.Method:A total of 92 cases of aged patients with total hip replacement were divided randomly into control group(n=46,underwent autologous blood transfusion)and observation group(n=46,underwent autologous blood transfusion combined with ANIH).MAP,HR,CVP,Hb,Hct,PT and APTT at before anesthesia(T0),5 min after anesthesia(T1),5 min after ANIH(T2),immediately after cleaning of acetabulum(T3),before autogolous blood reinfusing(T4)and at end of surgery(T5)were recorded in two groups.Intraoperative hemorrhage,autologous blood volume,allogeneic blood infusion volume,allogeneic blood transfusion cases and adverse reactions were compared between two groups.Erythrocyte filterability index,2,3-2-diphosphoglyceric acid,Ca2+concentration in erythrocyte were measured in salvaged blood.Result:Compared with that at T1,CVP at T2 and T3 increased(P<0.01)in observation group.Compared with that in control group,CVP at T3 increased(P<0.05).Compared with those at T0,Hb and Hct at T2 and T3 decreased(P<0.01),APTT at T2 and T3 extended(P<0.05).Compared with those in control group,Hb and Hct at T3 decreased(P<0.05),and Hb and Hct at T5 increased(P<0.05)in observation group.The volume and cases of allogenic blood transfusion in observation group were lower than those in control group(P<0.05).Compared with those in control group,erythrocyte filterability index and Ca2+concentration in erythrocyte decreased(P<0.05)and 2,3-2-diphosphoglyceric acid in erythrocyte increased(P<0.05)in observation group.Conclusion:ANIH combined with intraoperative autologous blood salvage might have good save blood effect,less influences for hemodynamics and coagulation function in aged patients with total hip replacement,so the erythrocyte in saved blood might be of high quality.
Objective:To evaluate the safety and effectiveness of acute non-isovolemic hemodilution(ANIH)combined with intraoperative autologous blood salvage for aged patients with total hip replacement.Method:A total of 92 cases of aged patients with total hip replacement were divided randomly into control group(n=46,underwent autologous blood transfusion)and observation group(n=46,underwent autologous blood transfusion combined with ANIH).MAP,HR,CVP,Hb,Hct,PT and APTT at before anesthesia(T0),5 min after anesthesia(T1),5 min after ANIH(T2),immediately after cleaning of acetabulum(T3),before autogolous blood reinfusing(T4)and at end of surgery(T5)were recorded in two groups.Intraoperative hemorrhage,autologous blood volume,allogeneic blood infusion volume,allogeneic blood transfusion cases and adverse reactions were compared between two groups.Erythrocyte filterability index,2,3-2-diphosphoglyceric acid,Ca2+concentration in erythrocyte were measured in salvaged blood.Result:Compared with that at T1,CVP at T2 and T3 increased(P<0.01)in observation group.Compared with that in control group,CVP at T3 increased(P<0.05).Compared with those at T0,Hb and Hct at T2 and T3 decreased(P<0.01),APTT at T2 and T3 extended(P<0.05).Compared with those in control group,Hb and Hct at T3 decreased(P<0.05),and Hb and Hct at T5 increased(P<0.05)in observation group.The volume and cases of allogenic blood transfusion in observation group were lower than those in control group(P<0.05).Compared with those in control group,erythrocyte filterability index and Ca2+concentration in erythrocyte decreased(P<0.05)and 2,3-2-diphosphoglyceric acid in erythrocyte increased(P<0.05)in observation group.Conclusion:ANIH combined with intraoperative autologous blood salvage might have good save blood effect,less influences for hemodynamics and coagulation function in aged patients with total hip replacement,so the erythrocyte in saved blood might be of high quality.
引文
[1]张艳杰,解永强,赵顺来,等.急性高容量血液稀释联合控制性降压对全髋关节置换患者异体输血和脑氧代谢的影响[J].临床血液学杂志,2017,30(12):944-947.
[2]骆喜宝,朱玉民,刘志贵,等.急性非等容性血液稀释联合氨甲环酸对脑肿瘤手术患者循环功能和血气电解质的影响[J].实用医学杂志,2015,31(19):3244-3246.
[3]陈献文.急性非等容血液稀释自储血回输技术的临床应用[J].北方药学,2015(8):191-192.
[4]李莉,任娟,刁建华,等.荧光法与原子吸收法检测慢型克山病和扩张型心肌病患者血液微量元素比较[J].中国地方病防治杂志,2016,31(6):603-604.
[5]喻君,金孝岠,郭建荣,等.不同血液稀释法对老年肝癌手术患者凝血及肝脏功能的影响[J].中国临床药理学与治疗学,2018,23(3):308-312.
[6]李卫,刘文值,朱月皓,等.急性非等容量血液稀释在脊柱手术中的应用[J].华西医学,2014,29(11):2063-2068.
[7] Amoroso M,Ozkan O,Bassorqun CI,et al.The effect of normovolemic and hypervolemic hemodilution on a micosurgical model:experimental study in rats[J].Plast Reconstr Surg,2015,136:412-419.
[8] Goldberg J,Paugh TA,Dickinson TA,et al.Greater volume of acute normovolemic hemodilution may aid in reducing blood transfusions after cardiac surgery[J].Ann Thorac Surg,2015,100:1581-1587.
[9]卢明军,郭建荣,王红军.不同血液稀释方法对老年骨科手术患者血流动力学的影响[J].西南国防医药,2017,27(1):60-62.
[10]朱玉民,骆喜宝,刘志贵,等.急性非等容量血液稀释联合氨甲环酸对凝血因子和失血量的影响[J].实用医学杂志,2015,31(13):2137-2139.
[11]朱明慧,王英,杨文丽,等.急性等容稀释联合回收式自体输血在前置胎盘手术中的应用[J].临床血液学杂志,2017,30(2):116-119.
[12]吴伟.术前稀释式联合术中回收式自体输血在心脏手术中应用[J].临床血液学杂志,2016,29(8):626-628.
[13]马文娟,卞茂红,郑美娟,等.体外贮存致悬浮红细胞凋亡损伤的研究[J].安徽医科大学学报,2015,50(2):189-193.
[2]骆喜宝,朱玉民,刘志贵,等.急性非等容性血液稀释联合氨甲环酸对脑肿瘤手术患者循环功能和血气电解质的影响[J].实用医学杂志,2015,31(19):3244-3246.
[3]陈献文.急性非等容血液稀释自储血回输技术的临床应用[J].北方药学,2015(8):191-192.
[4]李莉,任娟,刁建华,等.荧光法与原子吸收法检测慢型克山病和扩张型心肌病患者血液微量元素比较[J].中国地方病防治杂志,2016,31(6):603-604.
[5]喻君,金孝岠,郭建荣,等.不同血液稀释法对老年肝癌手术患者凝血及肝脏功能的影响[J].中国临床药理学与治疗学,2018,23(3):308-312.
[6]李卫,刘文值,朱月皓,等.急性非等容量血液稀释在脊柱手术中的应用[J].华西医学,2014,29(11):2063-2068.
[7] Amoroso M,Ozkan O,Bassorqun CI,et al.The effect of normovolemic and hypervolemic hemodilution on a micosurgical model:experimental study in rats[J].Plast Reconstr Surg,2015,136:412-419.
[8] Goldberg J,Paugh TA,Dickinson TA,et al.Greater volume of acute normovolemic hemodilution may aid in reducing blood transfusions after cardiac surgery[J].Ann Thorac Surg,2015,100:1581-1587.
[9]卢明军,郭建荣,王红军.不同血液稀释方法对老年骨科手术患者血流动力学的影响[J].西南国防医药,2017,27(1):60-62.
[10]朱玉民,骆喜宝,刘志贵,等.急性非等容量血液稀释联合氨甲环酸对凝血因子和失血量的影响[J].实用医学杂志,2015,31(13):2137-2139.
[11]朱明慧,王英,杨文丽,等.急性等容稀释联合回收式自体输血在前置胎盘手术中的应用[J].临床血液学杂志,2017,30(2):116-119.
[12]吴伟.术前稀释式联合术中回收式自体输血在心脏手术中应用[J].临床血液学杂志,2016,29(8):626-628.
[13]马文娟,卞茂红,郑美娟,等.体外贮存致悬浮红细胞凋亡损伤的研究[J].安徽医科大学学报,2015,50(2):189-193.