急性等容血液稀释和部分换血对胸腹主动脉手术中血液制品使用、止血和血流动力学的影响。一项针对连续患者的队列研究。

Effects of acute normovolaemic haemodilution and partial exchange transfusion on blood product utilization, haemostasis and haemodynamics in surgery of the thoracoabdominal aorta. A cohort study in consecutive patients.

作者信息

Cinà C S, Clase C M, Bruin G

机构信息

Division of Vascular Surgery, Department of Surgery, McMaster University, Hamilton, Canada.

出版信息

Panminerva Med. 2000 Sep;42(3):211-5.

PMID:11218628

Abstract

BACKGROUND

This paper outlines the technique of acute normovolaemic haemodilution with partial exchange transfusion (ANHPET) in surgery of the thoracic and thoracoabdominal aorta. Perioperative coagulation parameters and patterns of blood product utilization observed with this technique are described and compared with results for historical controls treated without ANHPET.

METHODS

During thoracoabdominal aneurysm repair, acute normovolaemic haemodilution with partial exchange transfusion (ANHPET) was used to withdraw of up to 3 L of blood. This was returned to the patient at the end of the reconstruction. Albumin 5% and stored packed red cells (PRC) were used for replacement. Seven patients underwent surgery with ANHPET, and fifteen without. Univariate and multivariate analysis of variance was used to examine differences between these groups.

RESULTS

No differences were observed between the two groups for estimated blood loss, PRC transfused, and postoperative haemoglobin concentration. The ANHPET group received fewer platelets (8 vs 22 units, p = 0.0004), cryoprecipitate (0 vs 13 units, p = 0.02), and desmopressin or epsilon-aminocaproic acid (0 of 7 vs 4 of 15 patients, p = 0.04). FFP use was not significantly different (11 vs 17 units). Postoperatively, PTT values were less prolonged (26 vs 34 sec, p = 0.05) and platelet concentration higher (218 vs 169 x 109/L, p = 0.01) in the ANHPET group. A significant reduction in the total of blood products transfused was observed in the ANHPET group (30 vs 68 units, p = 0.003). Control of hypertension was facilitated by phlebotomy so that nitroglycerine was necessary in low doses only (0.25-1.0 microgram/kg/min).

CONCLUSIONS

ANHPET reduced blood product transfusion, improved postoperative haemostatic parameters and simplified the management of cross-clamping hypertension.

摘要

背景

本文概述了在胸主动脉和胸腹主动脉手术中采用部分置换输血的急性等容血液稀释技术（ANHPET）。描述了该技术观察到的围手术期凝血参数和血液制品使用模式，并与未采用ANHPET治疗的历史对照结果进行比较。

方法

在胸腹主动脉瘤修复过程中，采用部分置换输血的急性等容血液稀释技术（ANHPET）抽取多达3升血液。在重建结束时将其回输给患者。使用5%白蛋白和储存的浓缩红细胞（PRC）进行置换。7例患者采用ANHPET进行手术，15例未采用。采用单因素和多因素方差分析来检验这些组之间的差异。

结果

两组在估计失血量、输注的PRC和术后血红蛋白浓度方面未观察到差异。ANHPET组输注的血小板较少（8单位对22单位，p = 0.0004）、冷沉淀较少（0单位对13单位，p = 0.02）以及去氨加压素或氨甲环酸较少（7例患者中的0例对15例患者中的4例，p = 0.04）。新鲜冰冻血浆的使用无显著差异（11单位对17单位）。术后，ANHPET组的部分凝血活酶时间值延长较少（26秒对34秒，p = 0.05）且血小板浓度较高（218对169×10⁹/L，p = 0.01）。ANHPET组输注的血液制品总量显著减少（30单位对68单位，p = 0.003）。放血有助于控制高血压，因此仅需低剂量硝酸甘油（0.25 - 1.0微克/千克/分钟）。