急性等容血液稀释对部分肝脏切除术患者肝功能及凝血功能的影响
The effect of acute normovolemic hemodilution on hepatic function and coagulation function in patients undergoing partial hepatectomy
李佳 1周维品 2杨勇 3韩伟 1周媛媛1
作者信息
- 1. 成都市第一人民医院麻醉科麻醉科,四川 成都 610041
- 2. 成都市双流区中医医院麻醉科,四川 成都 610299
- 3. 成都市第一人民医院麻醉科肝胆外科,四川 成都 610041
- 折叠
摘要
目的 探讨急性等容血液稀释(ANH)对部分肝脏切除术患者肝功能及凝血功能的影响.方法 选取我院收治的行部分肝脏切除术的患者64 例,采用随机数字表法分为试验组和对照组(ANH组)各32 例,对照组行常规麻醉,试验组行ANH.比较两组患者麻醉诱导前(T1)、血液稀释后30 min(T2)、术毕(T3)、术后24h(T4)、术后 72h(T5)的肝功能、凝血功能及肾功能指标变化.结果 试验组异体输血量、异体输血患者数少于对照组(P<0.05),两组总失血量比较差异无统计学意义(P>0.05);与T1 时比较,两组谷草转氨酶(AST)、谷丙转氨酶(ALT)均上升,总蛋白(TP)下降,试验组白蛋白(ALB)于T4时上升,对照组ALB于T3 时上升,两组比较差异有统计学意义(P<0.05);两组纤维蛋白原(FIB)下降、活化部分凝血酶原时间(APTT)上升(P<0.05);试验组凝血酶原时间(PT)上升,凝血酶时间(TT)则在T4 时下降,试验组T2～T3 时的PT、TT高于对照组(P<0.05);两组T1、T4、T5 时的肾功能指标比较差异无统计学意义(P>0.05).结论 ANH可在一定程度上减少患者异体输血量,对于行部分肝脏切除术的患者肝功能及凝血功能无显著负面影响,可用于临床推广.
Abstract
Objective To investigate the effect of acute normovolemic hemodilution(ANH)on hepatic function and coagulation function in patients undergoing partial hepatectomy.Methods A total of 64 patients who underwent partial hepatectomy in our hospital were selected.They were divided into a control group and a treatment group by using random number table method,32 in each group.The control group was given conventional treatment,while the treatment group was treated with ANH.The changes in hepatic function,coagulation function and renal function indicators before anesthesia induction(T1),at 30 min after hemodilution(T2),at the end of surgery(T3),at 24 h after surgery(T4)and 72 h after surgery(T5)were compared between the two groups.Results The amount of allogeneic blood transfusion and patients receiving allogeneic blood transfusion in the treatment group were smaller/fewer than those in the control group(P<0.05).However,there was no statistically significant difference in total blood loss between the two groups(P>0.05).Compared with T1,the levels of aspertate aminotransferase(AST)and alanine transaminase(ALT)were increased,and total protein(TP)was decreased in both groups.Albumin(ALB)in the treatment group was increased at T4,while ALB in the control group was increased at T3(P<0.05).The fibrinogen(FIB)was decreased and activated partial throm-boplastin time(APTT)was increased in both groups(P<0.05).The prothrombin time(PT)in the treatment group was increased,and thrombin time(TT)was decreased at T4.PT and TT in the treatment group at T2 and T3 were longer than those in the control group(P<0.05).There was no statistically significant difference in renal function indicators between the two groups at T1,T4 and T5(P>0.05).Conclusions ANH can reduce the amount of allogeneic blood transfusion in patients undergoing partial hepatectomy to a certain extent without significant influence on hepatic function and coagulation function.It can be used for clinical promotion.
关键词
肝脏切除术/血液稀释/肝功能/凝血功能Key words
Hepatectomy/Hemodilution/Hepatic function/Coagulation function引用本文复制引用
基金项目
四川省科技计划资助项目(2021JDKP0078)
出版年
2024
NETL
NSTL
万方数据