發(fā)布時(shí)間：2018-02-02 10:28

  本文關(guān)鍵詞： 急性等容血液稀釋 快速康復(fù)外科 肝葉切除術(shù) 免疫功能　出處：《實(shí)用醫(yī)學(xué)雜志》2017年14期 　論文類型：期刊論文

【摘要】：目的觀察急性等容血液稀釋(ANH)聯(lián)合快速康復(fù)外科(ERAS)對(duì)肝葉切除術(shù)患者的效果及免疫功能影響。方法肝葉切除術(shù)患者80例,隨機(jī)分成:ANH+ERAS組(AE組)和對(duì)照組(C組)。均全麻下手術(shù),C組常規(guī)輸液;AE組行ANH,并應(yīng)用ERAS。記錄術(shù)中輸液量、出血量、尿量及術(shù)后臨床指標(biāo):排氣及排便時(shí)間、進(jìn)食全流質(zhì)及住院時(shí)間。于麻醉誘導(dǎo)前(T_1)、術(shù)畢即刻(T_2)、術(shù)后1(T_3)、3(T_4)、7 d(T_5)抽血檢測(cè):CD4~+,CD8~+,CD4~+/CD8~+,NK cell水平。結(jié)果與T0比較,E組T_(2-3)時(shí)點(diǎn)CD3~+、CD4~+及NK細(xì)胞指標(biāo)下降,CD8上升。與E組比較,AE組無(wú)輸異體血病例;術(shù)后臨床指標(biāo)時(shí)間均縮短;T_(2-3)時(shí)點(diǎn)CD3~+、CD4~+、CD4~+/CD8~+及NK細(xì)胞升高,CD8~+降低,差異有統(tǒng)計(jì)學(xué)意義(P0.05)。結(jié)論 ANH復(fù)合ERAS可減少肝葉切除術(shù)患者輸注異體血,減輕對(duì)免疫功能的抑制,縮短術(shù)后住院時(shí)間等,值得臨床推廣。
[Abstract]:Objective to observe the effect of acute isovolumetric hemodilution (ANH) combined with rapid rehabilitation surgery (ERASS) on hepatectomy and its immune function. They were randomly divided into two groups: the control group (group C) and the control group (group A). Group C was given routine infusion under general anesthesia. ANHs were used in AE group and ERAS.Intraoperative infusion volume, blood loss, urine volume and postoperative clinical indexes: exhaust and defecation time, total fluid intake and hospitalization time were recorded before anesthesia induction. At the end of the operation, T2 was put in place immediately after the operation. After the operation, 1 T3 + T + 3 / T + 3 / T / T / T / T / T / T were collected for 7 days.) the blood samples were taken to detect CD8 ~ / CD8 ~ / CD4 ~ / CD8 ~ + / CD4 ~ / CD8 ~. Results compared with T _ 0, CD _ 3 ~ T _ 4 ~ and NK cell index decreased and CD8 increased in E group. No allogeneic blood transfusion was found in AE group. The time of clinical indexes was shortened after operation. The levels of CD4 ~ / CD8 ~ and NK cells increased and CD8 ~ decreased at the time point of T _ (2 ~ 3). Conclusion ANH combined with ERAS can reduce the transfusion of allogeneic blood, reduce the inhibition of immune function and shorten the postoperative hospital stay in patients undergoing hepatectomy. It is worth popularizing in clinic.
【作者單位】： 中山大學(xué)附屬佛山醫(yī)院麻醉科;中山大學(xué)附屬佛山醫(yī)院肝臟外科;
【基金】：廣東省臨床重點(diǎn)�？平ㄔO(shè)資金資助項(xiàng)目(編號(hào):粵衛(wèi)(2011)144) 佛山市醫(yī)學(xué)類科技攻關(guān)項(xiàng)目(編號(hào):2015AB00301)
【分類號(hào)】：R614
【正文快照】： 如何減少術(shù)中出血及輸異體血,是臨床關(guān)注的問(wèn)題。其中急性等容血液稀釋(acute normovolemic he-modilutio,ANH)是一種操作簡(jiǎn)便、經(jīng)濟(jì)實(shí)用的血液保護(hù)措施,可提供新鮮自體血液回輸,減少異體血輸注[1-3]。而患者術(shù)后康復(fù)也是熱點(diǎn)問(wèn)題,快速康復(fù)外科(enhanced recovery after surge

【參考文獻(xiàn)】

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