Matot Idit, Scheinin Olga, Jurim Oded, Eid Ahmed
Department of Anesthesiology and Critical Care Medicine, Hadassah University Medical Center, The Hebrew University of Jerusalem, Israel.
Anesthesiology. 2002 Oct;97(4):794-800. doi: 10.1097/00000542-200210000-00008.
Liver resection is a major operation for which, even with the improvements in surgical and anesthetic techniques, the reported rate of blood transfusion was rarely less than 30%. About 60% of transfused patients require only 1 or 2 units of blood, a blood requirement that may be accommodated by the use of acute normovolemic hemodilution (ANH).
The efficacy, hemodynamic effects, and safety of ANH were investigated in a randomized, active-control study in patients with American Society of Anesthesiologists status I-II who were undergoing major liver resection with fentanyl-nitrous oxide-isoflurane anesthesia. Patients were randomized to the ANH (n = 39) or control group (n = 39). Patients in the ANH group underwent hemodilution to a target hematocrit of 24%. The indication for blood transfusion was standardized. In both groups transfusion was started at a hematocrit of 20%. The primary efficacy endpoint was the avoidance of allogeneic blood transfusion in the intraoperative period and first 72 h after surgery. Various laboratory and hemodynamic parameters as well as postoperative morbidity were monitored to define the safety of ANH in this patient population.
During the perioperative period, 14 control patients (36%) received at least one unit of allogeneic blood compared with 4 patients (10%) in the ANH group ( < 0.05). The hemodilution process was not associated with significant changes in patients' hemodynamics. Morbidity was similar between the control and the ANH groups. Postoperative hematocrit levels and biochemical liver, renal, and standard coagulation test results were similar in both groups.
Acute normovolemic hemodilution in patients with American Society of Anesthesiologists status I-II undergoing major liver resection may allow a significant number of patients to avoid exposure to allogeneic blood.
肝切除术是一项大型手术，即便外科手术和麻醉技术有所进步，但报道的输血率很少低于30%。约60%的输血患者仅需1或2单位血液，这种用血需求可通过急性等容血液稀释（ANH）来满足。
在一项随机、阳性对照研究中，对美国麻醉医师协会分级为I-II级、接受芬太尼-氧化亚氮-异氟烷麻醉下大型肝切除术的患者，研究急性等容血液稀释的疗效、血流动力学效应及安全性。患者被随机分为ANH组（n = 39）或对照组（n = 39）。ANH组患者血液稀释至目标血细胞比容为24%。输血指征标准化。两组均在血细胞比容为20%时开始输血。主要疗效终点是术中及术后72小时内避免异体输血。监测各种实验室和血流动力学参数以及术后发病率，以确定急性等容血液稀释在该患者群体中的安全性。
围手术期，对照组14例患者（36%）接受了至少1单位异体血，而ANH组为4例患者（占10%）（P<0.05）。血液稀释过程与患者血流动力学的显著变化无关。对照组和ANH组的发病率相似。两组术后血细胞比容水平以及肝脏、肾脏生化指标和标准凝血试验结果相似。
美国麻醉医师协会分级为I-II级且接受大型肝切除术的患者，急性等容血液稀释可使相当数量的患者避免接触异体血。
