等容血液稀释自体输血对肿瘤患者围术期内环境和凝血功能的影响(1)
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[摘要]目的 观察和比较术中等容血液稀释自体输血和异体输血对肿瘤患者围术期机体内环境和凝血功能的影响。方法选择直肠癌、结肠癌和胃癌根治术患者40例，随机分为两组。A组术中输异体全血400mL；B组于手术切皮前放血400mL，同时输入等量羟乙基淀粉，术中自体血回输给患者。结果 A组输血后lh及术后24h pH值和HCO3-下降较B组明显(P<0.05) ；B组稀释后Hb明显低于A组(P<0.05)；血常规其余各值、PT、APTT、FIB在各测定点两组变化一致，两组间均无显著差异(P>0.05)。结论在一定范围内，等容血液稀释自体输血有利于维持肿瘤患者围术期内环境稳定，等容血液稀释自体输血与异体输血相比对凝血功能的影响差异不显著。
[关键词]输血；自体输血； 内环境；血液凝固
[中图分类号] R457.1 [文献标识码]A[文章编号] 1673-9701(2011)27-03-03
Normovolumic Hemodilution Autologous Blood Transfusion in Environment and Coagulation of Cancer Patients During the Perioperative
SHAO Ya YAN Guozhang
Zhejiang Province Ningbo City Yinzhou People's Hospital， Ningbo 315040，China
[Abstract] Objective To observe and compare the technical medium hemodilution autologous blood and allogeneic blood transfusion in cancer patients perioperative environment for the body and blood coagulation. Methods Cancer， colon cancer and gastric cancer 40 patients were randomly divided into 2 groups. A group of patients lost allogeneic whole blood 400mL； B group before the surgical incision bleeding 400mL， also entered the same amount of hydroxyethyl starch， intraoperative autologous blood to the patient. Results A group of post-transfusion after lh and 24h pH values and HCO3-decreased significantly compared with group B (P<0.05)； B diluted Hb group was significantly lower than group A (P<0.05)； Blood remaining value， PT， APTT， FIB measurement points in the two groups were consistent between the two groups，and there were not significantly difference (P>0.05). Conclusion Within a certain range， such as hemodilution autologous blood transfusion will help cancer patients maintain a stable environment perioperative period，isovolemic hemodilution autologous blood transfusion with allogeneic blood transfusion compared to the effects on blood coagulation was not significant.
[Key words] Blood； Autologous blood transfusion； Perioperative environment；Blood coagulation
肿瘤患者围术期的异体输血可能会导致身体内环境产生紊乱并使自身发生凝血障碍，进而导致术后发生感染或肿瘤复发的可能性增加。而在有关通过对自体等容血液进行稀释、输血是否会对肿瘤患者的凝血功能和内环境产生影响报道却极少。为了对自体输血在临床应用中的价值进行探讨，本研究就自体等容血液稀释输血和异体血液输血对肿瘤患者围术期凝血功能及内环境的影响进行对比、分析，现报道如下。
1 资料与方法
1.1 研究对象
本组研究中40例病例均为 2009年1月～2011年 1月在本院采用根治术治疗胃癌、结肠癌和直肠癌的ASAⅠ～Ⅱ级患者 ......
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