Observation of Coagulation Change during Induced Hypotensive Anesthesia and Autologous Plasma Transfusion

低血壓麻醉及自體血漿輸血下凝血功能變化的觀察

劉玉成(Yue-Cheng Liu) ； 何謂明(Wai-Meng Ho) ； 康訓銘(Hsun-Ming Kang) ； 左海生(Hai-Sen Tso)

《Acta Anaesthesiologica Sinica》 32卷3期 (1994/09) Pp. 159-164

摘要

Coagulation change was studied in 16 adult female patients undergoing radical hysterectomy with BPLND surgery. None had preoperative alterations in coagulation or liver function and was receiving anticoagulant or antiplatelet medication. Sixteen ASA class I-II were divided into 2 groups randomly with eight patients in each group. One group accepted autologous plasma transfusion near the end of surgery, the other group did not. Autologous plasma was retrieved by plasma saver post induction of anethesia. Every patient received induced hypotensive anesthesia during the operation. Whole blood coagulation status was quantitated by using thromboelastography (TEG). Blood samples for TEG were obtained before induction of anesthesia, after closure of peritoneum, and 2 hours post autologous plasma transfusion or 2 hours post peritoneum closure. Most parameters measured by TEG showed improved coagulation status in autologous plasma transfusion group. We concluded that coagulation change was minimal during induced hypotension, and improved coagulation was obtained 2 hours post autologous plasma transfusion during radical hysterectomy with BPLND surgery.

關鍵字

Induced hypotension/Controlled hypotension ； Coagulation-thromboelastography ； Plasma saver

並列摘要

十六位預定接受子宮根除術合併兩側骨盆淋巴腺摘除術的女性病人被選擇用來進行手術中凝血功能變化的研究。每一位病人術前皆沒有凝血功能或是肝臟功能的異常，也投有接受任何抗擬血或抗血小板凝固的藥物治療。每一位病人皆屬於ASA Class I-II的病人，並被隨意分成兩組。其中一組於近手術結束時接受自體血漿輸血，另一組則否。自體血漿是於麻醉誘導後經由Plasma Saver取得。同時每一位病人於手術時皆接受低血壓麻醉處理。並由Thromboelastography（TEG）對每一位病人的血液凝固情況作一定量的分析。TEG所需的血液樣本分別於麻醉誘導前、腹膜關閉後、以及自體血漿輸血後兩小時或者腹膜關閉後兩小時分別抽取。TEG所測得的指數大多顯示病人於接受自體血漿輸血後，凝血狀況皆有明顯的改善。我們的結論是在單純低血壓麻醉時，接受子宮根除術合併兩側骨盆淋巴腺摘除術的病人凝血狀況並不會有明顯的變化。但於接受自體血漿輸血後，凝血功能會更為改善。