Influences of acute normovolemic hemdilution on blood protection, blood gas indexes, blood coagulation function and renal function in ectopic pregnancy surgery
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摘要: 目的：探讨急性等容血液稀释（ANH）在异位妊娠手术中的节血效果及对血气指标、凝血功能和肾功能的影响。方法：90例异位妊娠手术患者随机分为观察组（n=45）和对照组（n=45）。观察组术前实施ANH；对照组不进行ANH。检测观察组ANH前后pH值、动脉血氧分压（PaO2）、动脉血二氧化碳分压（PaCO2）、碳酸氢根（HCO3-）、碱剩余（BE）及血乳酸（LAC）。于术前（T0）、ANH后30 min（T1）、自体血回输前（T2）及自体血回输后（T3）检测观察组血红蛋白（Hb）、血细胞压积（HCT）、血小板数（PLT）、纤维蛋白原（Fib）、凝血酶原时间（PT）、部分凝血活酶时间（APTT）、凝血酶时间（TT）、D-二聚体（D-D）。检测观察组术前和术后24、48 h的血清β2微球蛋白（β2-MG）、血尿素氮（BUN）、血肌酐（Scr）水平。比较2组围术期失血量、输血量等指标。结果：①观察组ANH后动脉血pH值、PaO2、PaCO2、HCO3-、BE、血乳酸等血气指标较ANH前均差异无统计学意义（均P>0.05）。②观察组T1、T2时Hb、HCT、PLT、Fib较T0时明显下降（P<0.05），D-D较T0时明显增高（P<0.05），T3时明显恢复（P<0.05）。T1、T2时PT、APTT、TT较T0时差异无统计学意义（P>0.05）。③观察组术后24及48 h的β2-MG、BUN及Cr水平较术前差异无统计学意义（P>0.05）。④观察组异体血输注量明显少于对照组（P<0.05）。结论：在异位妊娠手术中应用ANH式自体输血，对患者的血气指标、凝血功能和肾功能无明显不良影响，具有一定的节约用血效果。Abstract: Objective: To explore the influences of acute normovolemic hemdilution on blood protection, blood gas indexes, blood coagulation function and renal function in ectopic pregnancy surgery.Method: A total of 90 patients with ectopic pregnancy were divided randomly into observation group(n=45) and control group(n=45).The patients in observation group were implemented ANH and the patients in control group were not carried out ANH.PH value, arterial blood oxygen partial pressure(PaO2), arterial blood carbon dioxide partial pressure(PaCO2), bicarbonate(HCO3-), alkali residue(BE) and blood lactate(LAC) before and after ANH were detected in observation group.Hemoglobin(Hb), hematocrit(Hct), platelet count(PLT), fibrinogen(Fib), thrombin time(PT), partial thrombin time(APTT), thrombin time(TT) and D-dimer(D-D) at preoperative(T0), 30 min after ANH(T1), before autogenous blood transfusion(T2) and after autogenous blood transfusion(T3) were detected in observation group.Serum β2-microglobulin(β2-MG), blood urea nitrogen(BUN) and blood creatinine(Scr) levels were detected at preoperative, postoperative 24 h and 48 h in observation group.Perioperative blood loss and blood transfusion were compared in two groups.Result: ① Compared with those before ANH, PH value, PaO2, PaCO2, HCO3-, BE and LAC after ANH were no obvious changes in observation group(P>0.05).② Compared with those at T0, Hb, Hct, PLT and Fib decreased(P<0.05) and D-D increased(P<0.05) at T1 and T2, and recovered obviously at T3(P<0.05), PT, APTT and TT at T1 and T2 were no obvious changes in observation group(P>0.05).③ Compared with those at preoperative, serum β2-MG, BUN and Scr levels at 24 h, 48 h after surgery were no obvious changes(P>0.05).④Allogeneic blood infusion in observation group was significantly less than that in control group(P<0.05).Conclusion: ANH had no obvious adverse effects on the blood gas index, coagulation function and renal function of patients with ectopic pregnancy, and had a certain effect of saving blood.
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