Chou G
Zhonghua Zheng Xing Shao Shang Wai Ke Za Zhi. 1989 Dec;5(4):259-61, 316-7.
From Nov. 1985 to Jun. 1988, we used the hemodilution in microsurgery. Of the 24 free flaps 22 survived and 2 failed. While the 17 free flaps in the patients without hemodilution, only 14 flaps survived. We think that the advantages of hemodilution applied to microsurgery are: 1. The common advantages in the field of surgery are to reduce amount of bleeding during the operation, to improve the blood perfusion to important organs, to avoid adverse blood reactions and to decrease the infectious diseases caused by the blood transfusion. 2. The outstanding advantages in microsurgery are as follows: (1) After moderate hemodilution had been performed, blood stickiness was so reduced that the resistance of blood stream was decreased. Because blood coagulation was reduced, bleeding and clotting time prolonged. The above-mentioned changes are beneficial to keep blood vessels unobstructed and also to prevent the free flaps from undergoing the crisis. (2) After moderate hemodilution has been performed, the speed of blood stream and the cardiac output were both increased, which made the free flaps be in a state of "overperfusion". The over-perfusion may both supply the free flaps with enough oxygen and eliminate metabolic products quickly, which will be beneficial for recovering of the flap shock and prevent the free flaps from occurring DIC.
1985年11月至1988年6月，我们在显微外科手术中应用了血液稀释法。在24例游离皮瓣中，22例存活，2例失败。而在未进行血液稀释的患者中的17例游离皮瓣，仅有14例存活。我们认为血液稀释法应用于显微外科手术的优点有：1. 外科领域的共同优点是减少手术中的出血量，改善重要器官的血液灌注，避免不良血液反应并减少输血引起的传染病。2. 显微外科手术中的突出优点如下：（1）进行适度血液稀释后，血液黏稠度降低，血流阻力减小。由于凝血减少，出血和凝血时间延长。上述变化有利于保持血管通畅，也有助于防止游离皮瓣出现危象。（2）进行适度血液稀释后，血流速度和心输出量均增加，使游离皮瓣处于“过度灌注”状态。过度灌注既能为游离皮瓣提供足够的氧气，又能迅速清除代谢产物，这将有利于皮瓣休克的恢复并防止游离皮瓣发生弥散性血管内凝血。
