Winter V, Gille J, Richter A, Sablotzki A, Wiedemann B
Anesteziol Reanimatol. 2006 Mar-Apr(2):43-7.
The efficacy of hypervolemic hemodilution (HHD) in reducing the rate of donor blood transfusion is controversely discussed. The present prospective, randomized, clinical study analyzes the impact of HHD with 6% hydroxyethyl starch (HES) 130/0.4 solution on the rate transfusion, laboratory parameters, and the incidence of complications as compared with those in the control group receiving no preoperative HHD.
80 patients who had undergone total prostatectomy or cystectomy were randomized into 2 groups. Before anesthesia, the HHD group (n=40) received 15 ml/kg of 6% HES 130/0.4 solution. In the HHD and control (n=40) groups, 6% HES 130/0.4 was intraintraoperatively infused in its maximum dose of 33 ml/kg according to the patients' needs. Indicationsf or blood transfusion trigger were Hb <5 g/dl or packed cell volume < 0.24. Laboratory parameters (Hb, PCV, platelets, prothrombin index, prothrombin time, thrombin time, fibrinogen, antithrombin III were measured before surgery, after HHD and 2, 24, and 48 hours after surgery. The mean blood pressure (MBP), heart rate (HR), and central venous pressure (CVP) were determined before surgery, after HHD, and 2 hours postsurgery. Statistical measurements were made in all patients from the HHD and control groups, as well as in a subgroup, in which intraoperative blood loss was greater than 30% of the total blood volume (70 ml/kg body weight).
Demographic data and surgical techniques were similar in both groups. After HHD, CVP rose significantly. The changes in MBP and HR were statistically insignificant. There were no complications after HHD. Of the 40 HHD-group patents, 5 needed donor blood transfusion while in the control group blood was transfused to 10 of the 40 patients in the control group. Comparing both groups showed a lower need for blood transfusion in the HHD-group patients than in the controls (10 versus 24 packed red cells). The postoperative Hb values showed no difference between both groups.
Preoperative HHD in patients undergoing surgery with expected >30% blood loss leads to decreased needs for blood transfusion. The method is safe and easy-to-use.
关于高容量血液稀释（HHD）在降低供血输血率方面的疗效存在争议。本前瞻性、随机、临床研究分析了使用6%羟乙基淀粉（HES）130/0.4溶液进行HHD对输血率、实验室参数以及并发症发生率的影响，并与未进行术前HHD的对照组进行比较。
80例行前列腺全切术或膀胱切除术的患者被随机分为两组。麻醉前，HHD组（n = 40）输注15 ml/kg的6% HES 130/0.4溶液。在HHD组和对照组（n = 40）中，术中根据患者需求以最大剂量33 ml/kg输注6% HES 130/0.4。输血触发指征为血红蛋白（Hb）< 5 g/dl或血细胞比容（PCV）< 0.24。在手术前、HHD后以及术后2、24和48小时测量实验室参数（Hb、PCV、血小板、凝血酶原指数、凝血酶原时间、凝血酶时间、纤维蛋白原、抗凝血酶III）。在手术前、HHD后以及术后2小时测定平均血压（MBP）、心率（HR）和中心静脉压（CVP）。对HHD组和对照组的所有患者以及术中失血量大于总血容量30%（70 ml/kg体重）的亚组进行统计测量。
两组的人口统计学数据和手术技术相似。HHD后，CVP显著升高。MBP和HR的变化无统计学意义。HHD后无并发症发生。HHD组的40例患者中，5例需要供血输血，而对照组的40例患者中有10例接受了输血。两组比较显示，HHD组患者的输血需求低于对照组（10单位与24单位浓缩红细胞）。两组术后Hb值无差异。
预期失血> 30%的手术患者术前进行HHD可减少输血需求。该方法安全且易于使用。
