中国医师杂志
中國醫師雜誌
중국의사잡지
JOURNAL OF CHINESE PHYSICIAN
2010年
7期
887-890
,共4页
杜金满%郭建荣%喻君%袁晓红%金宝伟%郭伟
杜金滿%郭建榮%喻君%袁曉紅%金寶偉%郭偉
두금만%곽건영%유군%원효홍%금보위%곽위
血液稀释%肝切除术%纤维蛋白纤维蛋白原降解物/代谢%凝血酶原/代谢%血小板活化%手术期间
血液稀釋%肝切除術%纖維蛋白纖維蛋白原降解物/代謝%凝血酶原/代謝%血小闆活化%手術期間
혈액희석%간절제술%섬유단백섬유단백원강해물/대사%응혈매원/대사%혈소판활화%수술기간
Hemodilution%Hepatectomy%Fibrin fibrinogen degradation products/ME%Prothrombin/ME%Platelet activation%Intraoperative period
目的 观察术前急性高容血液稀释(AHH)对老年肝癌根治手术患者围术期凝血指标和血小板活化功能的影响.方法 择期在全麻下行肝癌根治手术老年患者30例,等分为AHH组和常规处理对照组(C组).观察患者在麻醉诱导前(T1)、AHH后30 min(T2)、术始1 h(T3)、术毕(T4)和术后24 h(T5)的血浆纤维蛋白单体复合物(SFMC)、凝血酶原片段F1+2(F1+2)和血小板膜糖蛋白(GPⅡb/Ⅲa和CD62P)变化;C组在相应时点监测同一指标.结果 AHH组异体血需求比例比C组明显减少(20%vs 53.3%,P＜0.01);AHH组在T2后PT、APTT、FIB值显著延长,组间比较差异无统计学意义(P＞0.05);TT、D-二聚体组内及组间比较差异无统计学意义(P＞0.05);两组SFMC、F1+2无显著变化;AHH组CD62P表达明显降低,T2、T3时分别为(1.37±0.4)%、(1.28±0.4)%,与T1(1.96±0.6)%比较,差异有统计学意义(P＜0.05),PAC-1表达亦呈现降低但差异无统计学意义(P＞0.05).结论 AHH用于老年肝癌根治手术对围术期凝血及纤溶功能无明显影响,对基本状况良好的老年患者,术前进行适度的AHH可减少异体输血量,提高病人对失血的耐受性.
目的 觀察術前急性高容血液稀釋(AHH)對老年肝癌根治手術患者圍術期凝血指標和血小闆活化功能的影響.方法 擇期在全痳下行肝癌根治手術老年患者30例,等分為AHH組和常規處理對照組(C組).觀察患者在痳醉誘導前(T1)、AHH後30 min(T2)、術始1 h(T3)、術畢(T4)和術後24 h(T5)的血漿纖維蛋白單體複閤物(SFMC)、凝血酶原片段F1+2(F1+2)和血小闆膜糖蛋白(GPⅡb/Ⅲa和CD62P)變化;C組在相應時點鑑測同一指標.結果 AHH組異體血需求比例比C組明顯減少(20%vs 53.3%,P＜0.01);AHH組在T2後PT、APTT、FIB值顯著延長,組間比較差異無統計學意義(P＞0.05);TT、D-二聚體組內及組間比較差異無統計學意義(P＞0.05);兩組SFMC、F1+2無顯著變化;AHH組CD62P錶達明顯降低,T2、T3時分彆為(1.37±0.4)%、(1.28±0.4)%,與T1(1.96±0.6)%比較,差異有統計學意義(P＜0.05),PAC-1錶達亦呈現降低但差異無統計學意義(P＞0.05).結論 AHH用于老年肝癌根治手術對圍術期凝血及纖溶功能無明顯影響,對基本狀況良好的老年患者,術前進行適度的AHH可減少異體輸血量,提高病人對失血的耐受性.
목적 관찰술전급성고용혈액희석(AHH)대노년간암근치수술환자위술기응혈지표화혈소판활화공능적영향.방법 택기재전마하행간암근치수술노년환자30례,등분위AHH조화상규처리대조조(C조).관찰환자재마취유도전(T1)、AHH후30 min(T2)、술시1 h(T3)、술필(T4)화술후24 h(T5)적혈장섬유단백단체복합물(SFMC)、응혈매원편단F1+2(F1+2)화혈소판막당단백(GPⅡb/Ⅲa화CD62P)변화;C조재상응시점감측동일지표.결과 AHH조이체혈수구비례비C조명현감소(20%vs 53.3%,P＜0.01);AHH조재T2후PT、APTT、FIB치현저연장,조간비교차이무통계학의의(P＞0.05);TT、D-이취체조내급조간비교차이무통계학의의(P＞0.05);량조SFMC、F1+2무현저변화;AHH조CD62P표체명현강저,T2、T3시분별위(1.37±0.4)%、(1.28±0.4)%,여T1(1.96±0.6)%비교,차이유통계학의의(P＜0.05),PAC-1표체역정현강저단차이무통계학의의(P＞0.05).결론 AHH용우노년간암근치수술대위술기응혈급섬용공능무명현영향,대기본상황량호적노년환자,술전진행괄도적AHH가감소이체수혈량,제고병인대실혈적내수성.
Objective To observe the effects of preoperative acute hypervolemic hemodilution (AHH) on coagulation and fibrinolysis on the elderly patients undergoing hepatic carcinectomy.Methods Thirty ASA Ⅰ～Ⅱ liver cancer patients over sixty years old undergoing scheduled elective hepatic carcinectomy were random divided into AHH group ( n = 15) and control group ( n = 15).AHH was performed by infusing 15 ～20ml/kg 6% Voluven ( 130/0.4) in a rate of 30ml/min on patients in AHH group,and the patients in control group were infused routinely lactated Ringer's solution.Blood samples were collected for measuring coagulation function and platelet activation before anesthesia (T1) ,30 minutes after AHH (T2),1 hour ( T3 ), immediately (T4) and 24 hours (T5) after operation in group AHH, and the similar procure was used in control group.Results There was significant difference in the volume of allergenic blood transfusions between the two groups(20% vs 53.3%, P ＜0.05).PT and APTT in both groups prolonged significantly after T2, 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 it had no significant changes.PAC-1 and CD62P expressions of group AHH were significantly lower T2, T3 ,respectively ( 1.37 ±0.4) %, (1.28 ±0.4) %, than those at T1 [( 1.96 ± 0.6) %] ( P ＜ 0.05 ).Compared with control group, CD62P was significantly lower in AHH group at T2 and T5.Conclusion It is safe to take AHH of Hct 25% to 30% during hepatic carcinectomy for elderly liver cancer patients without cardiac and pulmonary disease.And it could decrease allergenic blood transfusions, with no apparently influence on coagulation function.
