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目的研究不同血液保护措施对肝癌患者术后异体输血量及复发、存活质量的影响。方法回顾性分析我院2009年3月至2011年3月行肝癌根治术患者129例,根据实施的血液保护措施的不同,将患者分为三组,每组43例,将采取急性等容血液稀释(ANH)的患者设置为ANH组,采取控制性低中心静脉压(LCVP)的患者设置为LCVP组,采取急性等容血液稀释联合控制性低中心静脉压(ANH+LCVP)的患者设置为ANH+LCVP组,统计各组患者术中出血和异体输血量情况,比较两组患者手术前后血小板参数(PLT)、血小板平均体积(MPV)、血小板分布宽度(PDW)及大血小板比率指标变化情况,对患者进行随访观察,比较各组患者复发率、生存时间以及生存质量。结果 ANH组术中失血量较LCVP组和ANH+LCVP组显著较多(P<0.05);ANH+LCVP组异体输血量较ANH组和ANH+LCVP组显著较低(P<0.05);ANH+LCVP组各血小板参数指标较ANH组显著较高(P<0.05),ANH+LCVP组PLT和MPV指标水平较LCVP组显著较高(P<0.05);ANH组5年生存率为25.58%较ANH+LCVP组46.51%显著较低(P<0.05),ANH组复发率为41.86%较ANH+LCVP组13.95%显著较高(P<0.05);ANH+LCVP组躯体功能、情绪功能、整体健康评分较ANH组和LCVP组显著较高(P<0.05)。结论 ANH+LCVP血液保护措施能有效降低肝癌患者术中失血量和异体血输注量,患者的血小板组织受到的破坏小,5年内生存率更高,复发率更低,保证了患者的预后,提高了术后存活质量。
Objective To study the effect of different blood protection measures on allogeneic blood transfusion, recurrence and quality of life of patients with liver cancer. Methods A retrospective analysis of our hospital from March 2009 to March 2011 in 129 patients with radical liver cancer surgery, according to the implementation of the different blood protection measures, the patients were divided into three groups, 43 cases in each group, will take acute isovolumic blood Patients in the ANH group were enrolled in the ANH group, those in the control LCVC group were assigned to the LCVP group, and patients who received acute isobaric hemodilution plus controlled low central venous pressure (ANH + LCVP) ANH + LCVP group, the blood loss and allogeneic blood transfusion in each group were statistically analyzed. The changes of platelet parameters (PLT), platelet volume (MPV), platelet distribution width (PDW) and the ratio of large platelet before and after operation were compared between the two groups The patients were followed up and compared the recurrence rate, survival time and quality of life in each group. Results The intraoperative blood loss in ANH group was significantly higher than that in LCVP group and ANH + LCVP group (P <0.05). The volume of blood transfusion in ANH + LCVP group was significantly lower than that in ANH group and ANH + LCVP group (P <0.05) The indexes of platelet parameters in LCVP group were significantly higher than those in ANH group (P <0.05), the levels of PLT and MPV in ANH + LCVP group were significantly higher than those in LCVP group (P <0.05); The 5-year survival rate in ANH group was 25.58% (P <0.05). The relapse rate was 41.86% in ANH group and 13.95% in ANH + LCVP group (P <0.05). The body function, emotional function, overall health score Which was significantly higher than ANH group and LCVP group (P <0.05). Conclusion The blood protection measures of ANH + LCVP can effectively reduce the intraoperative blood loss and allogeneic transfusion volume of patients with liver cancer. The platelet destruction of patients is small. The 5-year survival rate is higher and the recurrence rate is lower, which ensures the patient’s prognosis, Improve the quality of postoperative survival.