[1]梁勇升,唐培佳,黄海林,等.急性等容血液稀释联合回收式自体输血在心脏瓣膜置换手术中的应用[J].医学信息,2023,36(14):104-107.[doi:10.3969/j.issn.1006-1959.2023.14.020]
　LIANG Yong-sheng,TANG Pei-jia,HUANG Hai-lin,et al.Application of Acute Isovolumic Hemodilution Combined with Salvaged Autologous Blood Transfusion in Cardiac Valve Replacement Surgery[J].Journal of Medical Information,2023,36(14):104-107.[doi:10.3969/j.issn.1006-1959.2023.14.020]
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急性等容血液稀释联合回收式自体输血在心脏瓣膜置换手术中的应用()
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医学信息[ISSN:1006-1959/CN:61-1278/R]

卷:
36卷
期数:
2023年14期
页码:
104-107
栏目:
论著
出版日期:
2023-07-15

文章信息/Info

Title:
Application of Acute Isovolumic Hemodilution Combined with Salvaged Autologous Blood Transfusion in Cardiac Valve Replacement Surgery
文章编号:
1006-1959（2023）14-0104-04
作者:
梁勇升; 唐培佳; 黄海林; 等
（广西医科大学第六附属医院/玉林市第一人民医院麻醉科，广西 玉林 537000）
Author(s):
LIANG Yong-sheng; TANG Pei-jia; HUANG Hai-lin; et al.
(Department of Anesthesiology,the Sixth Affiliated Hospital of Guangxi Medical University/the First People’s Hospital of Yulin,Yulin 537000,Guangxi,China)
关键词:
急性等容血液稀释; 回收式自体输血; 心脏瓣膜置换手术
Keywords:
Acute isovolumetric hemodilution; Salvaged autologous blood transfusion; Cardiac valve replacement surgery
分类号:
R457.1；R542.5
DOI:
10.3969/j.issn.1006-1959.2023.14.020
文献标志码:
A
摘要:
目的 观察急性等容血液稀释联合回收式自体输血技术在心脏瓣膜置换手术中应用的效果及安全性。方法 选择2022年6月-12月在我院行心脏瓣膜置换手术的患者80例，按数字表法随机分为急性等容血液稀释联合回收式自体输血组（A组）和回收式自体输血组（B组），每组40例。A组在麻醉诱导后、肝素化前进行急性等容性血液稀释并采集一定量的血液保存，在鱼精蛋白拮抗肝素后回输所采自体血；同时对整个手术过程术野出血、体外循环管道余血进行血液回收并充分清洗后回输。B组对整个手术过程术野出血、体外循环余血进行血液回收并充分清洗后回输。比较两组术中术后异体输血量、异体输血率、术后12、24 h出血引流量、心脏外科ICU留观时间、术前及术后12、24 h凝血酶原时间（PT）、活化部分凝血活酶时间（APTT）、凝血酶时间（TT）、纤维蛋白原（FIB）、血红蛋白（Hb）、红细胞压积（Hct）、血小板计数（PLT）水平。结果 两组术后12、24 h PT、APTT、TT较术前延长、FIB较术前下降，且B组术后12、24 h PT、APTT、TT长于A组，FIB低于A组（P＜0.05）；两组术后12、24 h Hb、Hct、PLT较术前下降，且B组低于A组（P＜0.05）；A组术中术后异体输血量、异体输血率、术后12、24 h出血引流量、ICU留观时间少于B组（P＜0.05）。结论 急性等容血液稀释联合回收式自体输血在心脏瓣膜置换手术中应用效果良好，对凝血功能影响小，可以减少术后出血引流量、异体输血量和异体输血率，有效节约用血，缓解血源紧张。
Abstract:
Objective To observe the efficacy and safety of acute isovolumic hemodilution combined with salvaged autologous blood transfusion in cardiac valve replacement surgery.Methods Eighty patients who underwent cardiac valve replacement surgery in our hospital from June to December 2022 were randomly divided into acute isovolumic hemodilution combined with salvaged autologous blood transfusion group (group A) and salvaged autologous blood transfusion group (group B), with 40 patients in each group. In group A, acute isovolumic hemodilution was performed after the induction of anesthesia and before heparinization and a certain amount of blood was collected for preservation, and autologous blood was reinfused after protamine antagonized heparin. At the same time, the surgical field hemorrhage and the rest of the blood from the cardiopulmonary bypass tube during the surgical procedure were recovered and washed sufficiently before reinfusion. In group B, the surgical field hemorrhage and the rest of the blood from cardiopulmonary bypass tube during the surgical procedure were recovered and washed sufficiently before reinfusion. The volume of intraoperative allogeneic blood transfusion, the rate of allogeneic blood transfusion, the volume of drainage at 12 h and 24 h after operation, the ICU observation time in cardiac surgery, the levels of prothrombin time (PT), activated partial thromboplastin time (APTT), thrombin time (TT), fibrinogen (FIB), hemoglobin (Hb), hematocrit (Hct), platelet count (PLT） before operation and at 12h and 24h after operation were observed.Results PT, APTT and TT at 12 and 24 h after operation in the two groups were longer than those before operation, FIB was lower than that before operation, and PT, APTT and TT at 12 and 24 h after operation in group B were longer than those in group A, FIB was lower than that in group A (P<0.05). Hb, Hct and PLT at 12 and 24 h after operation in the two groups were lower than those before operation, and those in group B were lower than those in group A (P<0.05). The intraoperative and postoperative allogeneic blood transfusion volume, allogeneic blood transfusion rate, postoperative 12 h, 24 h bleeding drainage volume and ICU observation time in group A were less than those in group B (P<0.05).Conclusion Acute isovolumic hemodilution combined with salvaged autologous blood transfusion has a good application effect in cardiac valve replacement surgery, and has little effect on coagulation function. It can reduce postoperative bleeding volume, allogeneic blood transfusion volume and allogeneic blood transfusion rate, effectively save blood and relieve blood source tension.

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更新日期/Last Update: 1900-01-01