A prospective randomized study comparing two techniques of perioperative blood conservation: Isovolemic hemodilution and hypervolemic hemodilution
A prospective randomized study comparing two techniques of perioperative blood conservation: Isovolemic hemodilution and hypervolemic hemodilution
复制标题
DOI：
10.1097/00000539-200211000-00005
复制
发表时间：
2002-11-01
影响因子：
5.7
通讯作者：
Sehgal, R
中科院分区：
文献类型：
--
作者：
Kumar, R;Chakraborty, I;Sehgal, R
我们比较了高容量血液稀释（HVH）和等容量血液稀释（IVH）作为标准条件下围手术期血液保护的方法。30例阿萨I/II级成人患者计划接受骨科、耳鼻喉科或普外科手术，预期失血量>500 mL，接受IVH（n = 15）或HVH（n = 15）。通过抽血和同时聚明胶肽（Hemaccel（R））输注（IVH）或在不抽血的情况下输注聚明胶肽，将其血液稀释至血细胞比容（Hct）为25%，从而产生高血容量（HVH）。在自体/同种异体输血之前，允许进一步失血至Hct 20%，以实现术后24小时Hct大于或等于25%。HVH时收缩压（P = 0.0107）和中心静脉压（P = 0.0281）明显升高。两组中，目标后稀释Hct 25%与达到的Hct之间的平均差异（MD）无统计学显著性（MD [95%置信区间; CI]，IVH为0% [-0.7%至0.7%]，HVH为0.6% [-0.1%至1.3%]）。两组中实际使用的同种异体血量相似，MD（95% Q为-7（-326至312））显著低于相应的预计量（IVH中MD [95% CI]，-581 mL [ -753至409 mL]; HVH中-376 mL [-531至2211）。两种技术在所用时间（MD [95% CI] = 7 min 0.5 - 14.5 min]）、所产生的成本（MD [95% CI] = 1.7美元-4.10美元-7.501美元）和所用聚明胶肽体积（MD [95% CI] =-6 mL / kg体重[-16至4 mL / kg体重]）方面相似。该研究发现IVH和HVH在显著减少围手术期同种异体血液需求、所需时间和费用方面相当。用于实现所需HVH的公式似乎是有希望的。
We compared hypervolemic hemodilution (HVH) and isovolemic hemodilution (IVH) as means of perioperative blood conservation under standardized conditions. Thirty ASA status I/II adults slated for orthopedic, ear-nose-throat, or general surgery with expected blood loss of >500 mL underwent either IVH (n = 15) or HVH (n = 15). They were hemodiluted to a hematocrit (Hct) of 25% by blood withdrawal and simultaneous polygeline (Hemaccel(R)) infusion (IVH) or by infusing polygeline without blood withdrawal, thus creating hypervolemia (HVH). Further blood loss to a Hct of 20% was allowed before autologous/allogeneic blood transfusion to aim for a 24-h postoperative Hct of greater than or equal to25%. Systolic blood pressure (P = 0.0107) and central venous pressure (P = 0.0281) were significantly higher during HVH. The mean difference (MD) between the target postdilution Hct of 25% and the Hct achieved was not statistically significant in either group (MD [95% confidence interval; CI], 0% [-0.7% to 0.7%] for IVH and 0.6% [-0.1% to 1.3%] for HVH). The actual amount of allogeneic blood used was similar in the two groups, with an MD (95% Q of - 7 (- 326 to 312), and was significantly less than the corresponding projected amount (MD [95% CI], - 581 mL [ -753 to -409 mL] in IVH; - 376 mL [ - 531 to - 2211 in HVH). The two techniques were similar in time taken (MD [95% Cl] = 7 min 0.5 to 14.5 min]), cost incurred (MD [95% CI] = $1.7 $4.10 to $7.501), and volumes of polygeline used (MD [95% CI] = - 6 mL / kg body weight [ - 16 to 4 mL / kg body weight]). This study found IVH and HVH comparable in significantly reducing perioperative allogeneic blood requirements, time needed, and cost incurred. The formula used for achieving the desired HVH appears promising.