不同血液稀释法对老年肝癌手术患者凝血及肝脏功能的影响

doi:10.12092/j.issn.1009-2501.2018.03.011

中国临床药理学与治疗学 ›› 2018, Vol. 23 ›› Issue (3): 308-312.doi: 10.12092/j.issn.1009-2501.2018.03.011

不同血液稀释法对老年肝癌手术患者凝血及肝脏功能的影响

喻君¹，金孝岠¹，郭建荣²，鲁美静¹，曹亚¹，常燕¹

¹皖南医学院第一附属医院麻醉科，芜湖 241001，安徽； ²上海市浦东新区第二军医大学附属公利医院麻醉科，上海 200135

收稿日期:2017-07-14 修回日期:2017-11-28 出版日期:2018-03-26 发布日期:2018-03-28
通讯作者: 金孝岠，男，本科，主任医师，教授，研究方向：麻醉与应激。 Tel: 13505530523 E-mail: jinxj@163.com
作者简介:喻君，女，硕士研究生，主治医师，研究方向：麻醉与应激。 Tel: 13695673510 E-mail: doctoryu2@163.com
基金资助:
皖南医学院中青年科研基金项目（WK201032F）

Effects of different hemodilution on hepatorenal coagulation and liver function of eldly patients underwent hepatectomy

YU Jun¹, JIN Xiaoju¹, GUO Jianrong², LU Meijing¹, CAO Ya¹, CHANG Yan¹

¹ Department of Anesthesiology, the First Affiliated Hospital of Wannan Medical College, Wuhu 241001，Anhui，China; ² Department of Anesthesiology，Gongli Hospital of the Second Military Medical University，Shanghai 200135, China

Received:2017-07-14 Revised:2017-11-28 Online:2018-03-26 Published:2018-03-28

摘要/Abstract

摘要：

目的: 观察急性等容血液稀释（ANH）和术前急性高容血液稀释（AHH）用于老年肝癌患者肝脏肿瘤切除术时对围术期血常规、凝血及肝脏功能的影响。方法: 选择全麻下行肝脏肿瘤切除术老年患者45例(ASAⅡ级，年龄60～70岁)，随机分为实验组ANH组（A组，n=15）、AHH组（B组，n=15）和对照组（C组，n=15）。A、B组患者分别在麻醉诱导后实施ANH和AHH，C组常规补液输血。观察病人在麻醉诱导前（T1）、血液稀释后30 min（T2）、术毕（T3）和术后24 h（T4）的血常规、凝血和肝脏功能指标的变化。结果: A组术前平均采血量为（740.00±134.99） mL；三组患者围术期出血量相近（P>0.05），A和B组术中分别有3例需输入异体血(20%)，C组术中有8例需输入异体血（53.3%），A组和B组异体血需求量比C组明显减少（P<0.01）；A和B组患者血红蛋白（Hb）、红细胞压积（Hct）在血液稀释后各时点与T1比较明显降低（P<0.01），与C组比较差异有统计学意义（P<0.05）；与T1比较，三组的总蛋白（TP）、白蛋白（ALB）在T2后逐渐降低，组间比较差异有统计学意义（P<0.05）；三组谷丙转氨酶（ALT）、谷草转氨酶（AST）在T2以后逐步升高（P<0.05），在T3、T4时点C组显著高于A组（P<0.05）；A组在ANH后血浆凝血酶原时间（PT）、活化部分凝血活酶时间（APTT）值与术前比较明显延长，但仍在正常范围以内，回输自体血后指标得到一定改善；三组血浆凝血酶时间（TT）、D-二聚体（D-D）值水平各时点在组内及组间比较差异无统计学意义。结论: ANH及AHH用于老年肝癌切除手术进行血液保护对血常规、凝血和肝脏功能无明显影响，可明显减少异体输血量。

关键词: 血液稀释, 肝癌手术, 血常规, 凝血功能, 肝功能

Abstract:

AIM: To observe the effects of preoperative acute normal volemic hemodilution (ANH) and acute hypervolemic hemodilution (AHH) on coagulation and liver function in the elderly patients undergoing hepatic carcinectomy. METHODS: Forty-five ASA Ⅱ liver cancer patients (sixty to seventy years old) undergoing scheduled elective hepatic carcinectomy were randomly divided into ANH group(group A, n=15), AHH group (group B, n=15) and the control group (group C, n=15). After tracheal intubation, ANH was performed by letting blood from the jugular vein at the rate of 200-300 mL/10 min and infusing the same volume Voluven (130/0.4) in group A，AHH was performed by infusing 15-20 mL/kg Voluven (130/0.4) at a rate of 30 mL/min in group B，and group C were infused lactated Ringer's solution routinely. Blood routine(Hb, Hct), liver function（TP, ALB, AST, ALT）and coagulation function(PT, APTT, TT, DD) were observed and compared before anesthesia (T1)，30 minutes after ANH/AHH (T2) ，end of operation (T3) and 24 hours after operation (T4) in group A and B, and the corresponding time in group C. RESULTS: The blood loss volume was similar in the three groups during operations．There was significant difference in the allogeneic blood transfusions between both of the hemodilution groups and the control group（P<0.05）．Compared with T1，the Hb and Hct decreased significantly after hemodilution in group A and B．The plasma protein also significantly decreased after ANH and AHH in group A and B as compared with T1．ALT，AST in each group increased significantly during operation（P<0.05），in T3 and T4 there was significant difference between the group A and C. PT and APTT in group A and B after hemodilution were significantly prolonged (P>0.05), but none of them shifted outside the normal range．No significant changes were found in D-dimer and TT in group A and B．CONCLUSION: ANH or AHH is relatively safe during hepatic carcinectomy for elderly liver cancer patients without cardiac and pulmonary disease．ANH or AHH with 6% hydroxyethyl starch could be well applied to the elderly patients and also decrease allogeneic blood transfusions, with no apparently impact on the blood routine, liver and coagulation function．

Key words: hemodilution, hepatectomy, the blood routine, liver function, coagulation function

中图分类号:

R614

喻君，金孝岠，郭建荣，鲁美静，曹亚，常燕. 不同血液稀释法对老年肝癌手术患者凝血及肝脏功能的影响[J]. 中国临床药理学与治疗学, 2018, 23(3): 308-312.

YU Jun, JIN Xiaoju, GUO Jianrong, LU Meijing, CAO Ya, CHANG Yan. Effects of different hemodilution on hepatorenal coagulation and liver function of eldly patients underwent hepatectomy[J]. Chinese Journal of Clinical Pharmacology and Therapeutics, 2018, 23(3): 308-312.

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不同血液稀释法对老年肝癌手术患者凝血及肝脏功能的影响

Effects of different hemodilution on hepatorenal coagulation and liver function of eldly patients underwent hepatectomy

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