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AHH程度对老年髋关节置换术中凝血功能、内脏灌注的影响
The effect of AHH on coagulation function and visceral perfusion in elderly patients undergoing hip replacement
收稿日期:  
DOI:10.3969/j.issn.1673-9701.2024.19.014
关键词:  髋关节置换术  急性高容量血液稀释  凝血功能  内脏灌注
Key Words:
基金项目:
作者单位
吴啸鸽 金华市中心医院麻醉科浙江金华 321000 
陈元良 金华市中心医院麻醉科浙江金华 321000 
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摘要:目的 探讨急性高容量血液稀释(acute hypervolemic hemodilution,AHH)程度对老年髋关节置换术患者术中凝血功能、内脏灌注的影响。方法 选取2021年1月至2023年6月于金华市中心医院行髋关节置换术的老年患者102例进行回顾性研究,患者均采用AHH、自体血回输与控制性降压,根据AHH程度将其分成A组(n=55)与B组(n=47)。A组设定目标稀释值为红细胞压积(hematocrit,HCT)30%,B组设定为HCT 25%。比较两组患者的一般资料、尿量、输液总量、出血量及麻醉诱导后(T0)、血液稀释后(T1)、术毕(T2)的心率、体温、凝血酶原时间(prothrombin time,PT)、纤维蛋白原(fibrinogen,FIB)、活化部分凝血活酶时间(activated partial thromboplastin time,APTT)、血小板(platelet,PLT)及胃黏膜二氧化碳分压(gastric intramucosal carbon dioxide tension,PgCO2)、胃黏膜pH值(gastric intramucosal pH,pHi)。结果 B组患者的扩容液体总量、输液总量显著多于A组(P<0.05)。两组患者T1的心率、体温显著低于T0与T2,B组患者T1的心率显著低于A组(P<0.05)。两组患者T1、T2的PT显著长于T0,FIB、PLT显著低于T0(P<0.05);B组患者T1、T2的PLT显著低于A组(P<0.05)。两组患者T1、T2的PgCO2显著高于T0,pHi显著低于T0(P<0.05),且B组患者T1、T2的pHi显著低于A组(P<0.05)。结论 AHH目标值设定为HCT 25%~30%的总体安全性高,其中目标值为HCT 25%时PLT水平更低,但亦在正常范围内,而PgCO2增高,pHi有所降低。
Abstract:Objective To investigate the effects of acute hypervolemic hemodilution (AHH) on coagulation function and visceral perfusion in elderly patients undergoing hip replacement. Methods A retrospective study was conducted on 102 elderly patients who underwent hip replacement in Jinhua Municipal Central Hospital from January 2021 to June 2023. All patients were treated with AHH, autologous blood transfusion and controlled hypotension, and were divided into group A (n=55) and group B (n=47) according to the degree of AHH. The target dilution value was 30% hematocrit (HCT) for group A and 25% HCT for group B. The general data, urine volume, total infusion volume, blood loss, and heart rate, body temperature, prothrombin time (PT), fibrinogen (FIB), activated partial thromboplastin time (APTT), platelet (PLT) and gastric intramucosal carbon dioxide tension (PgCO2), gastric intramucosal pH (pHi) after anesthesia induction (T0), hemodilution (T1) and postoperative (T2) were compared between two groups. Results The total amount of expanded liquid and infusion in group B was higher than that in group A (P<0.05). The heart rate and body temperature of T1 in two groups were lower than those of T0 and T2, and heart rate of T1 in group B was lower than that in group A (P<0.05). The PT of T1 and T2 was longer than that of T0, FIB and PLT were lower than those of T0 (P<0.05). PLT of T1 and T2 in group B was lower than that in group A (P<0.05). PgCO2 of T1 and T2 in two groups was higher than that of T0, pHi was lower than that of T0 (P<0.05), and pHi of T1 and T2 in group B was significantly lower than that in group A (P<0.05). Conclusion The overall safety of AHH is high when the target value is 25% to 30% of HCT. When the target value is 25% of HCT, PLT level is lower, but it is also in the normal range, while PgCO2 is increased, pHi is decreased.
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