Erol Demet Dogan, Erdogan Yücel
Department of Anaesthesiology and Reanimation, Kocatepe University, School of Medicine, Dumlupinar Mah. Huseyin Tevfik Cad. No 11/8, 03200, Afyonkarahisar, Turkey.
Adv Ther. 2008 Feb;25(2):148-51. doi: 10.1007/s12325-008-0014-1.
Increased awareness of the risks related to homologous blood transfusions such as immunological reactions, transmission of infections, and immunosuppression, has necessitated exploration of alternative techniques to deal with the needs of intra-operative blood transfusion. Strategies that reduce or remove the risks associated with allogeneic transfusion include pre-operative autologous donation, peri-operative cell-salvage techniques, deliberate hypotension, and pharmacological interventions. Acute normovolaemic haemodilution is another such technique.
The effect of acute normovolaemic haemodilution on haemodynamics and blood gas parameters was studied in a male patient (58 y, 94 kg, American Society of Anesthesiologists physical status I) undergoing an orthopaedic surgical procedure for joint arthroplasty. After induction of general anaesthesia, 1600 ml of blood was collected and replaced with an equal volume of 6% hexaethyl starch.
Haemoglobin and haematocrit concentrations were significantly lower following haemodilution (14.9 and 9.2 g/dl for haemoglobin versus 45.0% and 31.7% for haematocrit). There was no significant change in the heart rate, blood pressure or end-tidal carbon dioxide tension throughout the operation period. Central venous pressure increased marginally from 5 to 90 min, but was within normal limits. There was no significant change in blood gas parameters following haemodilution. Platelet count decreased following haemodilution but the values were within normal limits.
Acute normovolaemic haemodilution with 6% hexaethyl starch is a safe procedure for blood conservation in selected operations. It did not cause any haemodynamic or blood gas parameters to change. It did not have any adverse effect on haemostatic mechanisms that could enhance the risk of bleeding at surgery.
人们越来越意识到同源输血相关的风险，如免疫反应、感染传播和免疫抑制，因此有必要探索替代技术来满足术中输血的需求。降低或消除异体输血相关风险的策略包括术前自体献血、围手术期细胞回收技术、控制性低血压和药物干预。急性等容血液稀释就是这样一种技术。
在一名接受关节置换骨科手术的男性患者（58岁，94公斤，美国麻醉医师协会身体状况I级）中研究了急性等容血液稀释对血流动力学和血气参数的影响。全身麻醉诱导后，采集1600毫升血液，并用等量的6%六乙基淀粉替代。
血液稀释后血红蛋白和血细胞比容浓度显著降低（血红蛋白分别为14.9和9.2克/分升，血细胞比容分别为45.0%和31.7%）。整个手术期间心率、血压或呼气末二氧化碳分压无显著变化。中心静脉压在5至90分钟略有升高，但在正常范围内。血液稀释后血气参数无显著变化。血液稀释后血小板计数降低，但数值在正常范围内。
用6%六乙基淀粉进行急性等容血液稀释是一种在特定手术中安全的血液保护方法。它不会导致任何血流动力学或血气参数发生变化。它对止血机制没有任何不良影响，不会增加手术出血风险。
