【摘要】 目的:研究急性血液稀释在孕产妇失血性休克中对循环及凝血功能的影响。方法:选择孕产妇合并失血性休克患者50例,随机分为对照组(Ⅰ组)和急性等容性血液稀释(ANH)组(Ⅱ组),每组25例。Ⅱ组于麻醉后、手术之前,在15～25min内经颈内静脉加压输入RLS及6%HES15～30ml/kg(晶∶胶=1∶1),使血容量迅速恢复。Ⅰ组除外血液稀释,其余处理同Ⅱ组。组间和组内比较各时点血流动力学、Hct、Hb、PLT、输血量及凝血功能等的变化。结果:血液稀释完成即刻(T1),Ⅱ组各生命指征与入室时(T0时点)比较,差异有非常显著性(P<0.01),显示休克生命征明显缓解;T1时点Ⅱ组各生命征与Ⅰ组比较,休克生命征缓解,有非常显著性差异(P<0.01)。Ⅱ组Hb、Hct和PLT、APTT、PT、FiB在T1时点较T0时点差异有非常显著性(P<0.01),显示血液明显稀释;输血量Ⅱ组明显少于Ⅰ组(P<0.01)。结论:急性血液稀释能迅速缓解孕产妇合并失血性休克患者的休克生命征,对凝血功能的影响并不影响患者的抢救成功率和治愈率,值得临床推广。更多还原

【Abstract】 Objective:Explore the effects of acute hemodilution on the circulation and blood coagulation in the hemorrhagic shock operation for pregnant and pregnant women.Methods:50 pregnant and pregnant women with hemorrhagic shock were recruited.They were equally divided into two groups:ⅠControl group,ⅡAcute normvolemic hemodilution(ANH)group.The 25 patients of group Ⅱ were pressurly infused in RLS and 6% HES,altogether 15～30 ml/kg(crystalylloid liquid:colloidal liquid=1∶1)through vena jugularis interna during the 15～25 minutes between anesthesia and operation,so that the blood volume would be restored quickly.The patients of the control group(I)were treated the same as the second group except the hemodilution.Then a close observation was made on the change of blood flow mechanics,Hct,Hb,PLT,blood transfusion amount,and blood coagulation inside and between the groups at different time points.Results:At the time point T1,when the hemodilution was finished,the vital signs of the patients of gro colloidal colloidal were significantly different from those at time point T0,when patients entered the operating room(P<0.01),which shows that the vital signs of the patients are relieved obviously(P<0.01);at the time point T1,the vital signs of the patients of group II are relieved much more obviously than those of groupⅠ(P<0.01).The big differences of Hb,Hct,PLT,APTT,PT,and FiB between T1 and T0 shows obvious hemodilution;the blood transfusion amount of group Ⅱis clearly less than that of groupⅠ(P<0.01);Conclusion:Acute hemodilution can quickly relieve the vital shock signs of pregnant and lying-in women with hemorrhagic shock,its effect on blood coagulation does not affect the success rate and cure rate of the rescue,so that this method is worth clinical promotion.更多还原