Acute Normovolemic Hemodilution in Coronary Artery Bypass Graft Surgery

冠狀動脈繞道手術中施行急性等容血液稀釋

柯道行(To-Ha ng Or) ； 楊敏文(Min-Wen Yang) ； 范文林(Wen-Lin Fan) ； 陳國瀚(Kwok-Hon Chan) ； 李德譽(Tak-Yu Lee)

《Acta Anaesthesiologica Sinica》 29卷2期 (1991/06) Pp. 586-591

摘要

Twenty patients undergoing coronary artery bypass graft (CABG) surgery in April through May, 1990 in our hospital were included in this study to evaluate the merits and practicability of autologous blood transfusion. About 1,000 ml of arterial blood were collected via a radial arterial line and stored in a plastic bag containing CPD solution immediately after induction of anesthesia. Colloid or crystalloid solution was used to replace the volume deficit after the blood sampling. At the end of cardiopulmonary bypass and after adequate reversal of heparinization by protamine, the blood previously sampled was re-transfused to the patient via a peripheral venous line. Thirty patients undergoing CABG surgery, who did not receive autologous blood transfusion from February to June, 1990 save April and May were assigned as control. Comparison of the data between the two groups was made using the Student's t-test, It was found that the intraoperative acute normovolemic hemodilution could lower the hemaotcrit by approximately 12%. Packed red blood cells (PRBC) given intraoperatively in the autologous group was only 2.0 ± 0.4 units whereas it was 5.3 ±0.7 units in the control group (p＜0.001). Fresh frozen plasma (FFP) given intraoperatively in the autologous group was only 1.8 ± 0.5 units whereas it was 6.6± 0.7 units in the control group (p＜0.001). The amount of platelets given intraoperatively in the autologous group was 1.9± 1.0 units against 9.3 ± 1.4 units in the control group (p＜0.001). Thus, acute normovolemic hemodilution in CABG surgery decreased intraoperative requirement of bank blood components including PRBC, FFP and platelets. By comparison of the amount of mediastinal shedding through the chest tube (747.9 ± 70.9 ml in the autologous group versus 865.0 ± 138.2 ml in the control group), it was apparent that the coagulation function in the patients receiving acute normovolemic hemodilution was not altered. The results also demonstrated that routine administration of platelets in CABG surgery might not be necessary.

關鍵字

Normovolemic hemodilution ； Autologous blood transfusion ； Coronary artery bypass graft surgery

並列摘要

本研究針對20位於去年4月及5月份在本院接受冠狀動脈繞道手術的病人，施行等容血液稀釋，評估其優點及可行性，他們被定為自體輸血組；從病人橈動脈放置導管採集約1000ml的動脈血，保存在一含有CPD溶液的塑膠袋內，採血引致的血量減少用膠性或結晶體溶液補充，於心肺機停用及heparinization完全以protamine中和後，之前收集的血液就通過一周邊靜脈輸回病人。於去年2月至6月份接受冠狀動脈繞道手術的病人，除了上述20位被定為自體輸血組外，其他則為對照組，共有30位病人，他們並沒有接受等容血液稀釋，兩組數據上的差異以Student's t-test予以分析比較。本研究中施行之急性等容量血液稀釋會降低病人血容量約12％。自體輸血組手術中接受之紅血球祇有2.0±0.4單位而對照組則為5.3±0.7單位（p＜0.001）。自體輸血組手術中接受之新鮮冷凍血漿為1.8±0.5單位，而對照組為6.6±0.7單位（p＜0.001）。自體輸血組手術中接受之血小板僅1.9±1.0單位而對照組為9.3±1.4單位（p＜0.001），所以於冠狀動脈繞道手術中應用急性等容血液稀釋可減少手術中紅血球、新鮮冷凍血漿及血小板的需求量。從胸管引流出之縱隔腔出血量（自體輸血組為747.9±70.9ml而對照組為865±138.2ml），可知自體輸血組的凝血功能似乎沒有改變。從這研究也得知雖兩組所接受的血小板單位數目不一樣（自體輸血組為1.9±1.0單位，而對照組為9.3±1.4單位），兩組手術後的血小板數目卻並無差異，所以在冠狀動脈手術中，似不一定需要常規地輸予血小板。