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目的 观察比较术前急性超容性血液稀释 (AHH )和急性等容性血液稀释 (ANH )作为血液保护技术在肝肿瘤手术病人的临床应用。方法 选择 45例ASAI -II级肝肿瘤手术病人 ,随机分为对照组 (n =15 ) ,超容性血液稀释组 (n =15 )和等容性血液稀释组 ( n=15 )。在麻醉诱导后 ,AHH组患者静脉快速滴注 2 0ml/kg液体 ,ANH组病人采血 15ml/kg保存体外同时输入等量 6%羟乙基淀粉。术中监测包括血压 ,心率 ,ECG ,氧饱和度 ,尿量 ,输液量和失血量。在血液稀释前后 ,手术结束和术后一天采血测定下列指标 :血红蛋白、红细胞压积、血小板 ,血液生化指标 ,凝血酶原时间 (PT)、激活凝血活酶时间 (APTT)。结果 AHH和ANH两组患者血液稀释后Hct分别由血液稀释前 ( 3 9 8± 3 4) %和 ( 4 0 2± 3 5 ) %下降到 ( 3 0 9± 3 3 ) %和 ( 2 9 6± 2 8) % ,血液稀释后AHH和ANH两组患者PT和APTT均有明显延长 (P <0 0 5 )。但是两组患者血液动力学稳定 ,血液生化指标无明显变化 ,与对照病人相比术中出血量无显著差异。AHH ,ANH和对照组分别有 4,3 ,9例患者需要输入异体血 ,对照组患者需要输入异体血总量明显多于AHH和ANH组 (P <0 0 5 )。结论 在ASAI -II级的肝肿瘤手术病人实施术前急性超容性血液稀释和等容性血液稀释技术可
Objective To observe the clinical application of preoperative acute hypervolemic hemodilution (AHH) and acute isobaric hemodilution (ANH) as a blood protection technique in liver cancer patients. Methods Forty-five ASAI-II hepatic tumors were randomly divided into control group (n = 15), hypervolemic hemodilution group (n = 15), and isotonic hemodilution group (n = 15). After induction of anesthesia, AHH group intravenous infusion of 20ml / kg liquid, ANH patients blood 15ml / kg stored in vitro while inputting the same amount of 6% hydroxyethyl starch. Intraoperative monitoring includes blood pressure, heart rate, ECG, oxygen saturation, urine output, fluid volume and blood loss. The following indicators were taken before and after hemodilution, end of surgery and day after surgery: hemoglobin, hematocrit, platelets, blood biochemical markers, prothrombin time (PT), activated thromboplastin time (APTT). Results The Hct after hemodilution in both AHH and ANH patients decreased from (398 ± 34)% and (42.02 ± 3.5)% to (39.93%) and (29 6 ± 28%). After the hemodilution, both PT and APTT of AHH and ANH patients were significantly prolonged (P <0.05). However, the two groups of patients with hemodynamic stability, no significant changes in blood biochemical indicators, compared with the control patients no significant difference in blood loss. AHH, ANH and control group were 4, 3, 9 patients need to enter allogeneic blood, the control group patients need to enter allogeneic blood was significantly more than AHH and ANH group (P <0 05). Conclusions The preoperative acute hypervolemic hemodilution and isovolumetric hemodilution can be performed in patients with ASAI-II grade liver tumor