von Bormann B, Boldt J, Kling D, Weidler B, Scheld H H, Hempelmann G
Abteilung für Anästhesiologie und operative Intensivemedizin der Universität Giessen.
Dtsch Med Wochenschr. 1987 Dec 4;112(49):1887-92. doi: 10.1055/s-2008-1068348.
Normovolemic hemodilution (15 mg/kg body-weight: group I) was undertaken in 100 patients immediately before the start of coronary-artery surgery. In addition, a Cell-Saver (Haemonetics, Munich) was used for intra-operative autotransfusion. Another group of 100 patients (group II) was similarly operated on without autotransfusion (the study was conducted on 200 consecutive patients undergoing aorto-coronary bypass). Before blood (autologous or homologous) was administered a reduction of hemoglobin to 9 g/100 ml and hematocrit to 0.28 was well tolerated (during extracorporeal circulation: 6.5 g/100 ml and 0.16, respectively). Due to intra- and postoperative complications, such as infarct bleeding (including reoperation) or septicemia, the number of patients placed in group I fell to 94, that in group II to 90. Acute normovolemic hemodilution increased cardiac output and oxygen transport capacity, while other hemodynamic parameters remained unchanged, and there was no effect on extravascular lung water. Autotransfusion reduced the need for homologous blood derivatives by 71% (fresh blood, fresh plasma, RBC concentrates). No clinically significant disadvantages occurred.
100例患者在冠状动脉手术开始前即刻进行了等容血液稀释（15mg/kg体重：第一组）。此外，术中使用了血液回收机（Haemonetics公司，慕尼黑）进行自体输血。另一组100例患者（第二组）在无自体输血的情况下进行了类似手术（该研究针对200例连续接受主动脉-冠状动脉搭桥术的患者开展）。在输注血液（自体或异体）前，血红蛋白降至9g/100ml、血细胞比容降至0.28的情况耐受性良好（体外循环期间分别为6.5g/100ml和0.16）。由于术中和术后并发症，如梗死出血（包括再次手术）或败血症，第一组患者数量降至94例，第二组降至90例。急性等容血液稀释增加了心输出量和氧输送能力，而其他血流动力学参数保持不变，且对血管外肺水无影响。自体输血使异体血制品（新鲜血液、新鲜血浆、红细胞浓缩物）的需求量减少了71%。未出现具有临床意义的不良情况。
