摘要
背景和目的
随着现代医学的不断发展，由异体输血引起的相关并发症引起人们的重视，其中病毒感染引起的肝炎、爱滋病等已成为严重的社会问题。新世纪我国将进一步面临血源短缺和输血后严重感染等严峻形势，因此如何在确保病人安全的前提下节约用血是当代医学研究的重要课题。术前自体贮血、麻醉后实施血液稀释、术中严密止血和血液回收及严格掌握输血指征等措施可减少围术期失血和异体血的应用，并起到很好的血液保护作用。近年来，术前血液稀释(Hemodilution，HD)已成为当前临床节约用血常用而有效的方法之一。主要有急性等容量血液稀释(Acute normovolemic hemodilution，ANH)和急性高容量血液稀释(Acute hypervolemic hemodilution，AHH)，AHH作为一种血液保护和液体治疗的新方法，具有操作简便，节约时间、费用低廉及减少血液污染等优点，目前已广泛应用于临床，并有逐步取代ANH之势。但国内外关于AHH对病人的酸碱平衡及电解质的研究甚少，而维持病人围术期的内环境稳定与病人的愈后密切相关，是一个值得深入研究的重要课题。
羟乙基淀粉液(Hydroxyethyl starch，HES)是近年来广泛应用的人工胶体。其中6％HES 200／0.5(以下简称贺斯HES)是中分子量低取代级羟乙基淀粉的等渗氯化钠溶液，具有扩充血容量和补充细胞外液的双重功效，扩容效应约为输入量的100％，维持4～8小时，有效维持血浆胶体渗透压，改善微循环灌注和组织氧供。而6％HES 130／0.4(以下简称万汶Voluven)是新一代羟乙基
Background and Objective
With the public concerns regarding the safety of transfused blood , how to avoid homologous blood transfusion and choose plasma substitutes has been an important topic. Preoperative autologous blood donation, postanaesthetic hemodilution (HD), improved surgical techniques , intra- and postoperative salvage of the patient's blood and its retransfusion, and acceptance of lower hemoglobin levels have all been used . Recent years, with the development of the study on the mechanism of hemodilution, preoperative hemodilution has become one of the most frequently used and effective technique for blood saving. It include two major methods: acute normovolemic hemodilution (ANH) and acute hypervolemic hemodilution (AHH). AHH is a new way of saving blood that was put forth in the nineties of twentieth century. To compare with acute normovolemic hemodilution (ANH), AHH save time and cost, and reduce contamination of blood, it will be more widely spread to use in clinic gradually. But the systemic investigation about the effect of preoperative acute hypervolemic hemodilution on acid-base equilibriumand and electrolyte is rare in clinic.
At present, there are a large variety of plasma substitutes (Hydroxyethyl starch,
引文
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