Objective To explore the combined application of predeposit autotransfusion and intraoperative hemodilution in surgical operation. Methods According to international predeposit autotransfusion standard, 19 ASA I -II patients with a greater estimated blood loss were selected. The blood sample (400 mL) was collected on the morning of days 2 and 3 in the fasting state and before induction of general anesthesia (total volume,800 mL). Patients were rapidly intravenously infused lactated Ringer's solution (500 mL) and Gelofusine (500 mL) before induction of general anesthesia. After the beginning of operation,patients received continuous infusion of lactated Ringer's solution and Gelofusine (the ratio of crystalloid to colloidal, 1: 1). Autotransfusion was started when large volumes of blood loss occurred and systolic blood pressure (SPB) fell to below 90 mmHg and completed before the end of operation. Allogeneic blood transfusion was performed when autotransfusion could not meet the requirement of blood transfusion. Red blood cell counts (RBC) ,hemoglobin (Hb) ,hematocrit (Hct),platelet count (PLT) and serum electrolytes (potassium,sodium,chloride and calcium) were detected before predeposit blood collection, hemodilution,autotransfusion and at the end of operation. SPB,diastolic blood pressure (DPB), heart rate (HR),liquid input volume before autotransfusion,intraoperative liquid input volume, allogeneic blood transfusion,and transfusion reactions were observed before hemodilution and induction of general anesthesia,and at the end of operation. Results The levels of RBC,Hb,Hct, PLT and serum calcium before autotransfusion and at the end of operation were lower than those before predeposit blood collection and hemodilution(P<0. 05) ,but the levels of chloride and HR before autotransfusion and at the end of operation were higher than those before predeposit blood collection and hemodilution(P<0. 05). The levels of RBC, Hb, Hct, SPB and DPB at the end of operation were higher than those before autotransfusion(P<0. 05) ,but the level of HR at the end of operation was lower than that before autotransfusion (P<0. 05). The average blood loss was (1 300±400)mL (range,900-1 900 mL) .accounting for (30±7)% of total blood volume (range, 22%-39%). The infused solution volume was 2 000-3 000 mL before autotransfusion and 2 500-4 000 mL at the end of operation. Five patients who received allogeneic red blood cell transfusion (2-3 U) had more than 1 600 mL of blood loss. Conclusion The combined application of predeposit autotransfusion and intraoperative hemodilution is safe and effective in surgical operation. But allogenic blood transfusion can not be avoided if excessive blood loss occurs during operation.%目的 探讨术前预存自体血液联合术中血液稀释在外科手术中的应用.方法 选择ASAⅠ -Ⅱ级、估计手术出血量较大、符合国内外预存自体输血标准的外科手术患者19例.入院后第2、3天早晨空腹时及全身麻醉诱导前采用一次性使用塑料血袋分别采血400 mL,共计800 mL.全身麻醉诱导前快速静脉输注乳酸钠林格液500 mL及血定安500 mL,手术开始后静脉继续输注乳酸钠林格液及血定安,晶胶比例为1∶1；手术出血较多、患者收缩压下降致90 mmHg以下时,开始反方向回输自体血液(自体血液回输不能满足输血需要时再考虑异体输血),并于手术结束前全部回输入患者体内.观察19例患者预存采血前、血液稀释前、自体血液回输前、手术结束时血常规[红细胞计数(RBC计数)、血红蛋白(Hb)、红细胞压积(Hct)、血小板计数(PLT)]、血清电解质(血清K+、Na+、Cl-、Ca2+)和血液稀释前、麻醉诱导前、自体血液回输前、手术结束时血压(SPB、DPB)、心率(HR)及自体血液回输前液体输入量、手术中液体输入总量、异体输血、输血反应等情况.结果 19例患者中,与预存采血前及血液稀释前比较,自体血液回输前及手术结束时RBC计数、Hb、Hct、PLT较低(P＜0.05)；与自体血液回输前比较,手术结束时RBC计数、Hb、Hct较高(P＜0.05)；与预存采血前及血液稀释前比较,自体血液回输前及手术结束时血清Cl-较高、血清Ca2+较低(P＜0.05)；与血液稀释前及麻醉诱导前比较,自体血液回输前SPB、DPB较低、HR较高(P＜0.05)；与自体血液回输前比较,手术结束时SPB、DPB较高、HR较低(P＜0.05).术中出血量900～1 900 mL,平均(1 300±400)mL;出血量所占全身血量比例为22％～39％,平均(30±7)％.自体血液回输前液体输入量2 000～3 000 mL、手术结束时液体输入总量为2 500～4 000 mL,晶胶比例为1∶1；5例出血量超过1 600 mL者,输异体血红细胞悬液2～3 U.结论 外科手术中采用术前预存自体血液联合血液稀释疗效较好,但手术中出现异常大量出血时仍需异体输血.
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