Objective: To evaluate the influence of preoperative moderate acute normovolemic hemodilution (ANH) with 6% hydroxyethyl starch(HES,200/0.5) on blood coagulation.Methods: Twenty ASA Ⅰ-Ⅱ patients scheduled for elective surgery were randomly assigned to receive moderate ANH with 6% HES.After induction of general anesthesia blood was withdrawn and collected before the onset of surgical blood loss,and at the same time replaced with HES.Measurements were obtained before and 15min after hemodilution and retransfusion of autologous blood.Results: After hemodilution APTT and PT were prolonged respectively from 30.50±4.50s and 12.66±1.03s to 34.48±3.62s and 14.14±0.86s(P<0.01).After retransfusion both of them could be used to normal range(P<0.01).Activated clotting time(ACT) had no changes all the while(P>0.05).After hemodilution both Fib and CR decreased significantly(P<0.01).Both of them increases significantly after retransfusion(P<0.01).Plt after hemodilution is less than that of before hemodilution significantly(P<0.01).PF decreased significantly(P<0.01) and TP was significantly(P<0.01) prolonged after hemodilution.Plt,PF and TP were resumed to a great extent(P<0.01).Conclusions: There was influence to some extent of moderate ANH with 6% HES on the function of coagulation.And platelet function could be shielded in ANH.
目的比较“基本认知能力测验”软件（2．0版）与由国际术后认知功能障碍研究协作组（International study of postoperative cognitive dysfunction，ISPOCD）推荐的测验方法对老年人术后认知功能障碍（postoperative cognitive dysfunction．POCD）的评估效果，并研究两种方法分测验之间的相关性。方法由同一专人采用两种方法分别于术前1d、术后7d、术后3个月对131例60岁-80岁，择期行非心脏手术的老年人进行认知功能的评估。同时设立对照组，30例未行手术的健康老年人，于相同时间间隔完成上述两套测验。“基本认知能力测验”（方法A）包括数字拷贝（A1），心算（A3）等，ISPOCD推荐的测验组合（方法B）包括连线测验（B1），符号数字模式测验（B2）等。两套测验的原始数据均采用Z计分法，Z≥2时判断患者发生了POCD。结果①131例入选患者中，120例完成术后7d测验，67例完成术后3个月测验。②术后7dPOCD检出率，方法A和方法B无统计学差异（分别为12．5％与10．8％，P＞0．05）；术后3个月POCD检出率亦无统计学差异（分别为5．97％与7．46％，P＞0．05）。③两种方法在术后7d和术后3个月对POCD的评估效果是一致的，Kappa为0．758与0．881，P＜0．05。④术后7d和术后3个月两种方法的组合“Z”计分之间均呈显著正相关（r为0．316与0．302，P＜0．05）。⑤在认知速度方面，数字拷贝（A1）与连线测验（B1）有显著相关性（r为0．517，P＜0．05）。在学习及工作能力方面，心算效率（A3）与符号数字模式测验（B2）有显著相关性（r为0．52，P＜0．05）。结论“基本认知能力测验”与ISPOCD推荐的测验方法对老年人POCD的评估效果相同。“基本认知能力测验”软件实用性强，在国人POCD评估方面具有临床应用价值。
