ANH与AHH在异位妊娠手术中的应用效果比较

摘要

Objective To compare the application effects of acute normovolemic hemodilution(ANH) and acute hypervolemic hemodilution (AHH) in ectopic pregnancy surgery. Methods 96 cases of surgical patients with ectopic pregnancy were randomly divided into ANH group,AHH group and control group,32 cases in each group. The patients in ANH group were received ANH after anesthesia induction and before the operation,the patients in AHH group were received AHH after anesthesia induction and before the operation,the patients in control group were not received acute hemodilution before the operation,the compound sodium lactate injection was infused after anesthesia induction and before the operation. The indicators such as Hb,Hct,BE,LAC were compared before and after acute hemodilution in ANH group and AHH group. Mean arterial pressure (MAP),heart rate(HR),cardiac index (CI) and stroke volume variation rate (SVV) at different time points were compared in ANH group and AHH group. The levels of Hb,Hct,PLT and cases of allogeneic blood transfusion were compared after the operation in three groups. Results ①The indicators such as Hb,Hct,BE,LAC were no statistical differences(P>0.05)before and after acute hemodilution in ANH group and AHH group. ② MAP,CI before and after autologous blood transfusion in ANH group was higher than those in AHH group(P<0.05),and SVV was lower than that in AHH group(P<0.05).③The levels of Hb、Hct、PLT at 2 h after the operation in ANH group were higher than those in AHH group and control group(P<0.05),the cases and volumes of allogeneic blood transfusion in ANH group were less than those in AHH group and control group(P<0.05). The cases and volumes of allogeneic blood transfusion in AHH group were less than those in control group(P<0.05). Conclusion ANH can effectively reduce the loss of red blood cells in ectopic pregnancy surgery and reduce allogeneic blood transfusion,has less influence on hemodynamics,safety performance is good,has a certain clinical value.%目的 比较急性等容血液稀释(ANH)与急性高容血液稀释(AHH)在异位妊娠手术中的应用效果.方法 将96例异位妊娠患者随机分为ANH组、AHH组和对照组,每组32例.ANH组和AHH组在麻醉诱导后、手术前分别行ANH和AHH,对照组术前不进行急性稀释性采血,麻醉诱导后、手术前输注复方乳酸钠注射液.比较ANH组与AHH组急性血液稀释前后血红蛋白(Hb)、红细胞压积(Hct)、碱剩余(BE)、血乳酸(LAC)等血气指标的变化水平;比较ANH组与AHH组各时点平均动脉压(MAP)、心脏指数(CI)、每搏量变异率(SVV)等血流动力学指标;比较3组术后Hb、Hct、血小板(PLT)水平及异体输血情况.结果 ①ANH组与AHH组血液稀释前后Hb、Hct及BE、LAC等血气指标的差异无统计学意义(P>0.05);②ANH组自体血回输前后MAP及CI明显高于AHH组(P<0.05),SVV明显低于AHH组(P<0.05);③ANH组术后2hHb、Hct、PLT水平明显高于AHH组及对照组(P<0.05),异体输血例数及异体红细胞输注量明显少于AHH组及对照组(P<0.05).AHH组异体血输注例数及异体红细胞输注量明显少于对照组(P<0.05).结论 ANH可有效减少异位妊娠术中红细胞的丢失,减少异体血输注,对血流动力学影响较小,输血安全性能良好,具有一定的临床应用价值.