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目的:探讨术前稀释式联合术中回收式自体输血在心脏手术中血液保护效果。方法:选择2013-03-2015-06行冠状动脉搭桥术、心脏瓣膜置换术、先天性心脏病矫治术患者156例为研究对象,以采用自体输血的患者86例作为自体输血组,以采用库血输注的患者70例作为库血输注组。记录2组患者失血量、库血输注量以及自体输血组术前预存血量和术中回收血量。观察2组手术前后RBC、Hb、HCT、WBC、PLT、PT、APTT等血液指标变化情况。观察2组输血不良反应发生及预后情况。结果:1自体输血组共有71例依靠术前预存血和术中回收血渡过围手术期,15例因术中出血或术后引流血过多输注了库存血,而库血输注组70例患者中有68例输注了库存血。自体输血组平均库血输注量为(1.79±1.16)U,明显低于库血输注组(5.69±1.60)U(P<0.05)。22组患者手术后第1天RBC、Hb、HCT、WBC、PLT、PT、APTT等血液指标与术前比较,差异均有统计学意义(均P<0.05),但2组间手术后第1天比较,差异均无统计学意义(均P>0.05)。3自体输血组未发生输血不良反应情况,库血输注组发生发热反应2例和过敏反应1例。结论:在心脏手术联合应用术前稀释式和术中回收式自体输血,可明显减少输注异体血量和输血不良反应,是一种安全有效的输血方式。
Objective: To investigate the blood protection effect of preoperative dilution combined with intraoperative recanalization of autologous blood transfusion in cardiac surgery. METHODS: A total of 156 patients undergoing coronary artery bypass grafting, heart valve replacement and congenital heart disease were enrolled in 2013-03-2015-06. Totally 86 patients with autologous blood transfusion were selected as autologous blood transfusion group. Seventy patients with blood transfusions were used as blood bank infusion group. Record 2 groups of patients blood loss, blood transfusion and autologous blood transfusion preoperative blood volume and intraoperative recovery of blood. The changes of blood indexes such as RBC, Hb, HCT, WBC, PLT, PT, APTT before and after operation were observed. The incidence of adverse reactions and the prognosis of the two groups were observed. A total of 71 cases of autologous blood transfusion group relying on preoperative blood preservation and intraoperative blood transfusion bypass surgery, 15 cases due to intraoperative bleeding or excessive drainage of blood after the infusion of blood bank, and blood bank infusion group Sixty of 70 patients were infused with stocked blood. The average volume of blood transfusion in autologous blood transfusions was (1.79 ± 1.16) U, which was significantly lower than that in blood transfusion group (5.69 ± 1.60) U (P <0.05). The blood parameters of RBC, Hb, HCT, WBC, PLT, PT and APTT in the 22 groups were statistically different from those before operation on the first day after operation (all P <0.05) There was no significant difference between days (all P> 0.05). 3 autologous blood transfusions adverse reactions did not occur in blood transfusion group 2 cases of fever and allergic reaction occurred in 1 case. Conclusion: The combination of preoperative cardiac surgery and postoperative recovery of autologous blood transfusion, can significantly reduce the amount of blood transfusions and transfusion adverse reactions, is a safe and effective blood transfusion.