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目的:评价急性等容血液稀释(ANH)式自体输血在异位妊娠手术中的应用价值。方法:选取96例异位妊娠大出血患者为研究对象,以采用ANH的50例患者为观察组,其余46例患者为对照组。记录观察组血液稀释前后动脉血pH、PaO2、PaCO2、HCO3-、碱剩余(BE)、血乳酸(LAC)等血气指标的变化情况。比较2组患者术前、术后1h、术后24hHb、Hct、PLT、凝血酶原时间(PT)、活化凝血活酶时间(APTT)、国际标准化比值(INR)等血液指标及C-反应蛋白(CRP)、白介素-6(IL-6)水平变化情况。比较2组患者出血量和异体输血量。结果:(1)观察组血液稀释前后pH、PaO2、PaCO2、HCO3-、BE、LAC等血气指标均无明显变化(P>0.05);(2)观察组术后1h的Hb、Hct水平明显低于对照组(P<0.05),但术后24h水平高于对照组(P<0.05)。观察组术后1h PT、APTT、INR明显延长(P<0.05),术后24h恢复正常。(3)与术前比较,2组术后1h和24hCRP及IL-6水平明显升高(P<0.05),但观察组CRP及IL-6水平明显低于对照组(P<0.05);2组出血量比较差异无统计学意义(P>0.05),2组异体血输注例数和异体输血量比较,差异有统计学意义(P<0.05)。结论:ANH对异位妊娠手术患者的血流动力学和凝血功能影响较小,可有效减轻炎症反应和减少异体血用量,具有一定的临床应用价值。
Objective: To evaluate the value of acute isovolemic hemodilution (ANH) autologous blood transfusion in ectopic pregnancy. Methods: Ninety-six patients with major bleeding in ectopic pregnancy were enrolled in this study. Fifty patients with ANH were selected as observation group and the other 46 patients as control group. The changes of arterial blood pH, PaO2, PaCO2, HCO3-, basic excess (BE), blood lactic acid (LAC) and other blood gas indexes before and after the hemodilution in the observation group were recorded. The blood levels of Hb, Hct, PLT, PT, APTT and INR were compared between the two groups before operation, 1h after operation, 1h after operation, and C-reactive protein (CRP), interleukin-6 (IL-6) levels. Blood loss and allogeneic blood transfusion in two groups were compared. Results: (1) There was no significant change in the blood gas indexes such as pH, PaO2, PaCO2, HCO3-, BE, LAC in the observation group before and after the hemodilution (P> 0.05). (2) The levels of Hb and Hct in the observation group were significantly lower In control group (P <0.05), but the level of 24h after operation was higher than that in control group (P <0.05). The PT, APTT and INR in the observation group were significantly prolonged at 1 hour after operation (P <0.05), and returned to normal at 24 hours after operation. (3) The levels of CRP and IL-6 at 1h and 24h after operation in both groups were significantly higher than those before operation (P <0.05), but the levels of CRP and IL-6 in the two groups were significantly lower than those in the control group (P <0.05); 2 There was no significant difference in bleeding volume between the two groups (P> 0.05). There were significant differences between the two groups in the number of allogeneic blood transfusion and allogeneic blood transfusion (P <0.05). CONCLUSIONS: ANH has less effect on hemodynamics and coagulation function in patients with ectopic pregnancy, which can effectively reduce the inflammatory reaction and reduce the amount of allogeneic blood, which has a certain clinical value.