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目的将成分单采技术用于预存式自体输血,评估其在成分式预存自体输血中的安全性、有效性。方法以普外科、骨科的择期手术患者中符合预存式自体输血指证患者109例为研究对象,分析比较术前采集自体全血、成分单采自体红细胞及未进行自体血预存的3组患者,术前、术后1 d、3 d Hb、Hct、Plt变化,及术后异体血输注率、术后平均住院日等指标,评价预存式自体成分输血的有效性。结果自体成分血组患者术后1 d、3 d Hb(117.66±18.02)g/L vs.(118.4±16.79)g/L vs.(143.6±10.96)g/L,P<0.05;Hct(36.26±4.63)%vs.(36.24±4.85)%vs.(43.17±3.15)%,P<0.05;Plt(201.29±58.09)×109/L vs.(202.28±48.06)×109/L vs.(240.11±72.29)×109/L,P<0.05均较术前下降;与术前比较自体全血组患者术后1 d、3 d Hb(139.43±12.11)g/L vs.(114.93±15.87)g/L vs.(112.72±17.9)g/L,P<0.05;Hct(42.45±3.08)%vs.(35.73±4.3)%vs.(34.08±5.44)%,P<0.05;Plt(242.36±56.25)×109/L vs.(205.84±65.73)×109/L vs.(197.89±54.71)×109/L,P<0.05均降低;对照组术后1 d、3 d较术前Hb(117.7±18.42)g/L vs.(112.62±18.2)g/L vs.(139.97±11.12)g/L,P<0.05;Hct(35.33±5.26)%vs.(33.73±5.42)%vs.(42.33±3.86)%,P<0.05;Plt(166.27±57.74)×109/L vs.(154.08±55.75)×109/L vs.(216.13±82.21)×109/L,P<0.05均降低,但3组患者术后Hb>110 g/L,Hct≥33%。3组患者术后1 d、3 d Hb、Hct变化差异无统计学意义(P>0.05),自体成分血组及自体全血组术后1 d、3 d Plt高于对照组(P<0.05)。自体成分血组与对照组比较有效缩短了术后平均住院日(17.93±7.13)d,(13.09±5.58)d,P<0.05,与自体全血组比较差异无统计学意义(13.09±5.58)d,(14.39±5.13)d,P>0.05。自体成分血组患者的异体血输注率与自体全血组比较差异无统计学意义(11.4%,22.7%,P>0.05)。结论将成分单采技术用于自体成分血输注,有利于缩短平均住院时间,降低异体血输注率,此技术用于自体成分输血具有可行性,安全有效。
OBJECTIVE: To use the component apheresis technique for pre-stored autologous blood transfusion to assess its safety and effectiveness in the fractional autologous blood transfusion. Methods One hundred and nine patients with preserved autologous blood transfusion in general surgery and orthopedic patients undergoing elective surgery were enrolled in this study. Three groups of patients with autologous whole blood collected from preoperative autologous erythrocytes and non-autologous blood were collected and analyzed. The changes of Hb, Hct, Plt on the 1st and 3rd postoperative day, and the rate of allogeneic blood transfusion, postoperative average length of stay and so on were evaluated to evaluate the effectiveness of prefilled autologous blood transfusion. Results Hb was significantly higher in patients with autologous component blood 1 day and 3 days after operation (117.66 ± 18.02 g / L vs 118.4 ± 16.79 g / L vs. 143.6 ± 10.96 g / L, P <0.05, respectively) ± 4.63% vs 36.24 ± 4.85% vs 43.17 ± 3.15%, P <0.05; Plt (201.29 ± 58.09) × 109 / L vs. (202.28 ± 48.06) × 109 / L vs. (240.11 ± 72.29) × 109 / L, P <0.05, respectively. Compared with preoperative, the level of Hb (139.43 ± 12.11) g / L vs. (114.93 ± 15.87) g / L vs. (112.72 ± 17.9) g / L, P <0.05; Hct (42.45 ± 3.08)% vs (35.73 ± 4.3)% vs (34.08 ± 5.44)%, P <0.05; (P <0.05). Compared with preoperative Hb (117.7 ± 0.05), P < (P <0.05); Hct (35.33 ± 5.26)% vs (33.73 ± 5.42)% vs (42.33 ± 0.62) g / L vs. (112.62 ± 18.2) g / L vs. (139.97 ± 11.12) g / P <0.05); Plt (166.27 ± 57.74) × 109 / L vs. (154.08 ± 55.75) × 109 / L vs. (216.13 ± 82.21) × 109 / L, P <0.05) Patients postoperative Hb> 110 g / L, Hct ≥ 33%. There was no significant difference in the Hb and Hct changes between the three groups at 1 and 3 days after operation (P> 0.05), while Plt at 1 d and 3 d after operation in autologous blood group and autologous whole blood group was higher than that in control group (P <0.05) ). Compared with the control group, the self-component blood group and the control group effectively shortened the average length of stay (17.93 ± 7.13) d and (13.09 ± 5.58) days, respectively, P <0.05. There was no significant difference between the autologous blood group and the control group (13.09 ± 5.58) d, (14.39 ± 5.13) d, P> 0.05. There was no significant difference in allogeneic blood transfusion rate between autologous blood group and autologous whole blood group (11.4%, 22.7%, P> 0.05). Conclusion It is feasible and safe to use the technique of component apheresis for blood transfusions of autologous components in order to shorten the average length of hospital stay and reduce the rate of allogeneic blood transfusion.