[高容量血液稀释作为预防同种异体输血的一种方法。急性等容血液稀释的一种简单替代方法]
[Hypervolemic hemodilution as a means of preventing homologous blood transfusion. A simple alternative to acute normovolemic hemodilution].
作者信息
Entholzner E, Mielke L, Plötz W, Malek A, Kling M, Burgkart R, Hargasser S, Hipp R
机构信息
Institut für Anasthesiologie, Klinikum rechts der Isar, Technischen Universität München.
出版信息
Fortschr Med. 1994 Oct 20;112(29):410-4.
PROBLEM
Acute normovolenic hemodilution (ANH) is timeconsuming and complicated, and has only a small effect in reducing the need for homologous blood. A simpler procedure is hypervolemic hemodilution (HHD). In the present prospective, randomized study, HHD is compared with ANH for its blood-saving effect.
STUDY DESIGN
Forty-nine patients undergoing total hip replacement were admitted. Group I (ANH): Withdrawal of 15 ml/kg bodyweight autologous blood and isovolemic replacement by hydroxyethyl starch (200/0.5). Group II (HHD): Infusion of 15 ml/kg bodyweight hydroxyethyl starch (200/0.5).
RESULTS
No significant differences were found between the groups in terms of Hb, hematocrit and coagulation. The blood loss (intra-operative+drainage losses) was comparable in the two groups at 1274 +/- 310 ml (HHD) and 130 +/- 335 ml (ANH). During the period under investigation, 66% of the patients in the HHD group and 57% in the ANH group required no homologous blood.
CONCLUSION
HHD is just as effective as ANH for reducing homologous blood requirements, and is much simpler to apply.
问题
急性等容性血液稀释（ANH）耗时且复杂，在减少同种异体血需求方面效果甚微。一种更简单的方法是高容性血液稀释（HHD）。在本前瞻性随机研究中，对HHD和ANH的血液节约效果进行了比较。
研究设计
纳入49例行全髋关节置换术的患者。第一组（ANH）：抽取15 ml/kg体重的自体血，并用羟乙基淀粉（200/0.5）进行等容置换。第二组（HHD）：输注15 ml/kg体重的羟乙基淀粉（200/0.5）。
结果
两组在血红蛋白、血细胞比容和凝血方面无显著差异。两组的失血量（术中+引流损失）相当，HHD组为1274±310 ml，ANH组为130±335 ml。在研究期间，HHD组66%的患者和ANH组57%的患者不需要同种异体血。
结论
HHD在减少同种异体血需求方面与ANH同样有效，且应用起来简单得多。
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