急性等容血液稀释对高龄全髋关节置换术患者围术期血小板活化功能的影响

摘要

Objective To observe the effects and clinical value of acute isovolemic hemodilution (ANH) on the level of PAC-1,CD62P and platelet in elderly patients undergoing total hip arthroplasty.Methods Forty elderly patients were randomly divided into ANH group and control group,and the changes of PAC-1 and CD62P at the times before anesthesia,30min after ANH,end of operation,one day and three days after operation were examined by flow cytometry.Results There were differences between ANH group and control group in the levels of PAC-1,CD62P and PLT besides at that of before anesthesia (P ＜ 0.05).The levels of PAC-1,CD62P and PLT were significantly decreased after hemodilution as compared with that of before anesthesia in ANH group;while the expressions of PAC-1 and CD62P were significantly increased at the end of operation as compared to that oft before anesthesia.But there was no significant change in PAC-1 and CD62P at three days after operation.After operation,the level of platelet was increased gradually.Conclusion ANH inhibites over-activation of platelet during perioperative period for elderly patients undergoing total hip arthroplasty and preventes deep vein thrombosis.%目的 观察急性等容血液稀释(acute isovolemic hemodilution,ANH)对高龄全髋关节置换术患者围术期血小板活化功能的影响及临床意义.方法 择期在全身麻醉下行全髋关节置换术患者40例,美国麻醉学会(ASA)Ⅰ或Ⅱ级,随机分为ANH组和对照组(n=20).采用流式细胞仪检测患者在麻醉诱导前、ANH后30min、术毕、术后1天和术后3天PAC-1和CD62P的表达.结果 两组患者除麻醉诱导前,其他各时间点纤维蛋白原受体(platelet activation complement-1,PAC-1)、P-选择素(P-selectin,又命名CD62P)和PLT水平差异均有统计学意义(P＜0.05).ANH组血液稀释后30min、PAC-1、CD62P和PLT水平都降低；术毕PAC-1和CD62P进一步活化,与麻醉诱导前比较差异有统计学意义(P＜0.05)；术后1天PAC-1和CD62P逐步下降,术后3天恢复到术前水平.而PLT术后各时间点,逐步回升,与麻醉诱导前比较差异有统计学意义(P＜0.05).结论 术前行ANH能抑制高龄全髋关节置换术患者围术期血小板的过度活化,对预防老年患者围术期血栓形成有一定的作用.