Kim Tae Yeon, Kim Dong Won, Jeong Mi Ae, Jun Jong Hun, Min Sung Jeong, Shin Su-Jin, Ha Tae Kyung, Choi Dongho
Department of Anesthesiology and Pain Medicine, Hanyang University College of Medicine, Seoul, Korea.
Department of Pathology, Hanyang University College of Medicine, Seoul, Korea.
Ann Surg Treat Res. 2018 Dec;95(6):312-318. doi: 10.4174/astr.2018.95.6.312. Epub 2018 Nov 26.
Acute normovolemic hemodilution (ANH) is an autologous transfusion method, using blood collected during surgery, to reduce the need for allogeneic blood transfusion. ANH is controversial because it may lead to various complications. Among the possible complications, anastomotic leakage is one that would have a significant effect on the operation outcome. However, the relationship between ANH and anastomotic site healing requires additional research. Therefore, we conducted this prospective study of ANH, comparing it with standard intraoperative management, undergoing gastric anastomosis in rats.
Sixteen Sprague-Dawley rats were randomly assigned to three groups: group A, surgery with ANH; group N, surgery with standard intraoperative management; and group C, sham surgery with standard intraoperative management. ANH was performed in group A animals by, removing 5.8-6.6 mL of blood and replacing it with 3 times as much crystalloid. All rats were enthanized on postoperative day 6, and histopathologic analyses were performed.
The mean hematocrit values, after hemodilution were 22.0% (range, 18.0%-29.0%), group A; 33.0% (29.0%-35.0%), group N; and 32.5% (29.0%-34.0%), group C. There were significant differences between groups A and N (P = 0.019, P = 0.009, P = 0.004, P = 0.039, and P = 0.027), and between groups N and C (P = 0.006, P = 0.027, P = 0.04, P = 0.008, and P = 0.009) with respect to inflammatory cell numbers, neovascularization, fibroblast numbers, edema and necrosis, respectively; there were no differences between groups A and N.
In rat model, anastomotic complications did not increase in the ANH group, compared with the standard intraoperative management group.
急性等容性血液稀释（ANH）是一种自体输血方法，即利用手术过程中采集的血液，以减少异体输血的需求。ANH存在争议，因为它可能导致各种并发症。在可能的并发症中，吻合口漏是一种会对手术结果产生重大影响的并发症。然而，ANH与吻合口愈合之间的关系需要进一步研究。因此，我们对ANH进行了这项前瞻性研究，并将其与标准术中管理进行比较，研究对象为接受胃吻合术的大鼠。
将16只Sprague-Dawley大鼠随机分为三组：A组，行ANH手术；N组，行标准术中管理手术；C组，行标准术中管理的假手术。对A组动物进行ANH，抽取5.8 - 6.6 mL血液，并用3倍量的晶体液进行置换。所有大鼠在术后第6天处死，并进行组织病理学分析。
血液稀释后，A组的平均血细胞比容值为22.0%（范围18.0% - 29.0%）；N组为33.0%（29.0% - 35.0%）；C组为32.5%（29.0% - 34.0%）。A组和N组在炎症细胞数量、新生血管形成、成纤维细胞数量、水肿和坏死方面存在显著差异（P分别为0.019、0.009、0.004、0.039和0.027），N组和C组在上述方面也存在显著差异（P分别为0.006、0.027、0.04、0.008和0.009）；A组和N组之间无差异。
在大鼠模型中，与标准术中管理组相比，ANH组的吻合口并发症并未增加。
