摘要
目的：在不需增改特殊设备条件下，可使整个如心脏瓣膜替换术、法乐四联症根治术等较大的手术围术期完全不输异体血。方法：选择体重２０公斤以上，血红蛋白≥１１０ｇ／Ｌ，红细胞压积≥０．３５，需行心内直视手术的患者２３例，采用术前采集自体血１～２次（１０ｍｌ·ｋｇ￣（－１）／次）结合术中血液稀释（麻醉后按１５ｍｌ／ｋｇ采自体血），机器预充液中一次性加入抑肽酶４万ＫＩＵ／ｋｇ等综合措施。与１９９４年１月至４月间连续２３例输异体血者作对照。用ｔ检验统计处理。结果：自体输血组围术期均不需输异体全血、红细胞和血小板。脑氧饱和度转机中与麻醉前比无显著差异（Ｐ＞０．０５），２４小时和总的纵隔心包引流量分别减少４３．０６％和４３．１０％，平均每例节省库血１６３５ｍｌ、血浆２０５ｍｌ．瓣膜替换术者血红蛋白术后２周为１０９ｇ／Ｌ、第４周为１１１ｇ／Ｌ。法乐四联症根治术者血红蛋白术后１周为１０８ｇ／Ｌ，第３周为１１２ｇ／Ｌ。全部患者均康复，大多数不到２周出院。结论：采用这种综合方法不需增改特殊设备、简便安全有效。
Objective: To study the outcome of major operations such as cardiac valve replacement,radical correction of tetrology of Fallot, etc. without perioperative homologous blood transfusion. Methods: From July 1994 to January 1995, 23 patients (group E, body weight 20 kg, Hb≥110 g/L,HCT≥0. 35) undergoing open heart surgery were studied.Autologous blood was collected 1-2 times preoperatively (10 ml/kg) and intraoperatively (after anesthesia, 15 ml/kg) with blood dilution, and aprotinin (40 000 KIU/kg) was applied in cardiopulmonary by pass(CBP) priming. Statistical analysis was performed with Student t test by comparing with 23 patients only received homologous donor blood (group C).Results: In group E, no homologous whole blood, red cells and platelets was transfused. Brain O2 saturation showed no significant difference (during CPB and pre-anesthesia) between the two groups. 24-hour and total postoperative mediastinal drainage decreased by 43.06% and 43. 10%, respectively, (both p<0.01, vs. group C) . On an average, 1635 ml bank whole blood and 205 ml plasma per case were saved. Hemoglobin (Hb) concentrations of patients in group E undergoing cardiac valve replacement were 109 g/L and 111 g/L on the 2nd and 4th week postoperatively, while those of patients undergoing operation for tetralogy of Fallot were 108 g/L and 112 g/L on the lst and 3rd week postoperatively. All of the patients of group E recovered smoothly and most of them were discharged within 2 weeks after operation. Conclusion: This combined measure do not need special equipment, and is simple, convenient, safe and effective.
出处
《中国循环杂志》
CSCD
1996年第2期90-92,共3页
Chinese Circulation Journal
关键词
自体输血
输血
心内直视手术
Autologous blood transfusion
Homologous blood
Open heart surgery
