von Bormann B, Weidler B, Schwanen N, Ratthey K, Hempelmann G
Abteilung Anaesthesiologie und operative Intensivmedizin, St. Johannes-Hospital, Duisburg-Hamborn.
Chirurg. 1990 Feb;61(2):124-8; discussion 129.
50 consecutive patients with hip arthroplasty had acute normovolaemic haemodilution and intra- and postoperative autotransfusion using Autotrans, Dideco GmbH. 18 of 50 patients received homologous blood products additionally to autotransfusion (Hb less than 8 g/dl, hemodynamic instability). There was no evidence for coagulation disorders, hypoxia or hypovolaemia during the whole investigation period (until the 10th p.o. day) though in some cases haemoglobin-levels less than 7 g% were accepted. No variations of erythropoietin levels could be observed postoperatively, suggesting that acute anaemia alone does not affect erythropoiesis. Reticulocytes, however, increased significantly from the 4th postoperative day. There was no correlation between number of reticulocytes and erythropoietin levels. Lactate levels stayed within normal range during the whole investigation period thus indicating normal microcirculation. The present data demonstrate that postoperative anaemia can be tolerated even in elder patients if intravascular volume is kept constant (normovolaemia). In accordance with recent literature the course of erythropoietin levels seemed to prove that there was no functional reduction in oxygen-availability.
50例连续行髋关节置换术的患者采用德国迪德科公司的Autotrans进行急性等容血液稀释及术中、术后自体输血。50例患者中有18例在自体输血的基础上还接受了同种异体血制品（血红蛋白低于8 g/dl，血流动力学不稳定）。在整个研究期间（直至术后第10天），未发现凝血障碍、缺氧或血容量不足的证据，尽管在某些情况下血红蛋白水平低于7 g%也被接受。术后未观察到促红细胞生成素水平的变化，这表明单纯急性贫血不影响红细胞生成。然而，网织红细胞从术后第4天起显著增加。网织红细胞数量与促红细胞生成素水平之间无相关性。在整个研究期间，乳酸水平保持在正常范围内，从而表明微循环正常。目前的数据表明，如果血管内容量保持恒定（等容），即使是老年患者也能耐受术后贫血。与最近的文献一致，促红细胞生成素水平的变化似乎证明氧利用率没有功能降低。
