中国实用外科杂志

中国实用外科杂志 ›› 2010, Vol. 30 ›› Issue (11): 949-951.

• 论著 • 上一篇    下一篇

急性等容血液稀释对老年肝癌病人围手术期凝血和纤溶功能的影响

郭建荣1，喻    君1，杜金满1，金孝岠2，郭    伟1，袁晓红1   

  1. 1宁波大学医学院附属李惠利医院麻醉科，浙江宁波 315040；2皖南医学院附属弋矶山医院麻醉科，安徽芜湖241000
  • 出版日期:2010-11-01 发布日期:2010-10-25

  • Online:2010-11-01 Published:2010-10-25

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摘要：

目的    观察急性等容血液稀释（ANH）用于老年肝癌切除手术时对凝血和纤溶功能的影响。 方法    选择2007年2月至2008年2月在宁波大学医学院附属李惠利医院行肝脏肿瘤切除手术的老年病人30例，对其围手术期凝血和纤溶功能影响的临床资料进行分析。将30例随机等分为ANH组（A组）和对照组（B组）。 结果    两组病人围手术期出血量差异无统计学意义（P>0.05），A组异体血需求量（350.0±70.7）mL比B组（457.0±181.3）mL明显减少（P<0.01）；两组在ANH 30min后凝血酶原时间（PT）、活化部分促凝血酶原激酶时间（APTT）值与麻醉诱导前比较显著延长，但仍在正常范围以内，A组回输自体血后指标得到一定改善；两组病人凝血指标凝血酶时间（TT）、D-二聚体（DD）组间比较差异无统计学意义（P>0.05）。两组病人围手术期的可溶性纤维蛋白单体复合物（SFMC）、凝血酶原片段1+2（F1+2）各时点组间比较差异无统计学意义（P>0.05）；与麻醉诱导前比较，A组病人ANH后30min 至术毕时间血小板膜糖蛋白（CD62P）表达明显低于B组（P<0.05），两组各时点组内比较差异无统计学意义（P>0.05）。  结论    ANH对老年肝癌切除病人围手术期的纤溶和凝血功能无显著影响，并可明显减少异体输血。

关键词: 肝癌, 急性等容血液稀释, 凝血功能

Abstract:

Effects of acute normovolemic hemodilution on coagulation and fibrinolysis in eldly patients undergoing hepatic carcinectomy        GUO Jian-rong*，YU Jun，DU Jin-man，et al．*Department of Anesthesiology，Lihuili Hospital，Medical College of Ningbo University，Ningbo 315040，China
Corresponding  author ：GUO Jian-rong，E-mail：jianrguo@126.com
Abstract    Objective    To observe the effects of acute normovolemic hemodilution (ANH) on coagulation and fibrinolysis on eldly patients undergoing hepatic carcinectomy．Methods    Thirty liver cancer patients (ASA ⅠorⅡ) over sixty years old performed hepatic carcinectomy from February 2007 to February 2008 at Lihuili Hospital，Medical College of Ningbo University were randomly divided into ANH group (groupA，n=15) and control group(group B，n=15)．Results    The perioperative blood loss was not significantly different between the two groups (P>0.05). The volume of allogeneic blood transfusion in ANH group was significantly less than that in control group [（350.0±70.7）mL vs.（457.0±181.3）mL, P<0.01]．Compared with before anesthesia induction，PT and APTT in both groups prolonged significantly at 30 minutes after ANH，but they all remained in normal range．TT and DD had no significant changes between the two groups．SFMC and F1+2 increased in both groups, but without statistical significance. PAC-1 and CD62P expressions of ANH group were significantly lower than before anesthesia induction（P<0.05）．Compared with group B，CD62P were significantly lower in ANH group after ANH．But there was no statistical significance between the two groups(P>0.05)．Conclusion    In elderly patients undergoing resection of liver cancer, ANH has no obvious impact on fibrinolysis and coagulation function. It could therefore be safe to reduce allogeneic blood transfusion largely．

Key words: hepatic carcinoma, acute normovolemic hemodilution, coagulation function