关节置换术后自体引流血回输的治疗评价

目的：观察人工关节置换术后自体引流血回输的治疗效果。方法：选择５１例４６佣全髋关节置换术，１４个全膝关节表面置换术患者分别随机分成自体引流血回输组和输库存血对照组，收集有关数据统计分析。结果：自体引流力丰总输血量４８．１％，输自体引流血无发热及其他输血并发症。结论：自体引流血另输安全有效，可节约血源，减少输异体血的潜在危险。     

心脏直视手术围术期自体输血的应用体会

为避免输血性传染病及并发症的发生，对２７３例心脏直视手术患者围术期行自体输血，取得了较好的效果。对自体输血过程中血液采集、血液贮存、自体血输注等有关问题进行讨论。认为自体输血是一种安全、经济、方便、不需特殊设备的输血方式，医患双方均应提高对自体输血的认识，推广自体输血，充分发挥自体输血的优势，避免及减少血源性传染病和输血并发症，提高医疗质量     

回输腹腔引流自体血在闭合性脾损伤非手术治疗中的应用研究

目的 探讨回输腹腔穿刺引流自体血在闭合性脾损伤非手术治疗中的安全性与可行性.方法 对2008年1月至2011年12月安徽省立医院急诊外科94例闭合性脾损伤患者进行综合评估,将其中符合非手术治疗指征并且具有输血指征的44例单纯性脾损伤患者随机(随机数字法)分为治疗组与对照组,观察两组间年龄、性别、创伤评分、损伤分级、腹腔引流血液有核细胞计数、淀粉酶、腹腔引流血液量、输血量及损伤至输血间隔时间有无显著差异,然后治疗组回输腹腔引流自体血,对照组输入异体红细胞,比较两组患者输血前后24 h以及治疗后在血液动力学、血液成分及凝血指标等方面的差异.结果 两组患者输血后血液动力学指标及贫血指标均显著改善;两组患者输血后各项生理指标变化差异无统计学意义.结论 伤情评估及腹腔穿刺引流血检验后,回输腹腔穿刺引流自体血可用于闭合性脾损伤非手术治疗,与输入异体红细胞同样安全有效.     

自体血引流回输在人工关节置换术患者中的应用

目的探讨自体血引流回输在人工关节置换术患者中的应用效果。方法选择我院2018年6—12月同一治疗组初次行人工髋关节、膝关节置换术患者79例,将单纯输注异体血患者49例作为对照组,自体血引流回输患者30例作为观察组,比较两组患者手术前后血红蛋白水平、红细胞计数及术中出血量、异体血输血量、术后引流量与输血反应和发热率。结果观察组患者异体输血量少于对照组(P 0. 05);两组患者术中出血量、手术前后血红蛋白水平与红细胞计数、术后引流量比较差异均无统计学意义(P 0. 05);两组患者均未发生输血反应、发热反应。结论自体血回输及异体血输注均可达到满意的临床治疗效果。自体血引流回输患者的异体输血量明显低于单纯输注异体血的患者。目前国内血源紧张,自体血引流回输可有效缓解临床用血紧张情况,值得临床推广使用。     

贮存式和稀释式自体输血在部分外科手术中的应用

现代输血医学已成为一门新的学科，输血在治疗和抢救病人中占有不可替代的重要地位。同种异体输血由于存在血源紧张和输血不良反应及各种输血传染病的危险，越来越受到社会的关注和患者自身的重视，从而使自体输血得到更加广泛的应用。笔者就78例自体输血在部分外科手术中开展贮存式和稀释式自体输血，取得效果满意。为了使自体输血积累更多的经验，现在报告如下。     

新的输血策略

“新的输血策略”试图最大限度减少同种异体输血而增加自体红细胞的应用,尽管并不是所有的临床状况都允许,但该方法仍被认为是近期输血的策略范例。医生和患者对输血风险的关心左右着这些策略。只要心肺的生理功能能可靠的承受心输出量和组织灌注,那么为了达到取代同种异体输血的目的,自体血液稀释技术、血细胞的回收利用及其预储存都是合理的策略。由血液管理讨论会提交的11项策略中,有六项支持这些     

自体输血现状的调查与分析

目的 探讨自体输血的现状以便指导今后的宣传内容及方向，消除传统观念和意识障碍、误区。方法 采用问卷方式随机调查我市市民对自体输血的了解程度，获取自体输血相关知识的欲望程度及获取信息的途径等内容。采用SPSS11．0统计软件包进行数据处理。结果 不同文化程度市民对自体输血的了解率、不同的获取身体输血相关知识的渠道及对自体输血影响健康的了解率的差别有统计学意义，其中在不同年龄段市民通过阅读报刊杂志与其他途径获取信息率的差别有统计学意义。结论 在实际工作中就宣传内容及方向而言，主管部门应加强指导；消除传统观念和认识误区；同时解决现存问题，积极推广这种安全、简单、经济的输血方式——自体输血，真正缓解血源紧张、保证输血的安全。     

自体输血在非手术保脾术中的临床应用

创伤时回收式自体输血的方法一般是术中自体输血 [1,2 ] ,即手术中收集体腔积血 ,经抗凝、过滤 ,再回输给患者。随着各类非手术保脾术的广泛开展 ,腹腔积血的动态观察、再利用研究 ,国内已有报道 [3 ,4] ,均系采用腹壁打洞置入乳胶管引流积血入引流瓶直接回输。此类方法创伤较大、易污染 ,且引流积血未经过滤、抗凝 ,回输有一定危险。为研究简便有效的积血回收方法 ,笔者应用经皮腹腔穿刺置管引流腹腔积血 ,并将早期引流积血收集入 CPD-A血液保存袋内回输 ,后期引流作腹腔出血动态观察 ,结果较为满意 ,现报告如下。对象与方法1　对象　 2 …     

术前信息化自体输血评估作用的调查分析

目的调查分析术前信息化自体输血评估流程对开展自体输血工作的促进作用。方法统计对比2012年1月—2017年9月本院自体输血例数及总量、主要手术科室的贮存式自体输血量及手术患者自体输血率、2016年1—9月与2017年同期全院及外科各种形式的自体输血例数及数量情况。结果 2016年本院贮存式自体输血和术中自体输血的例数、输血量均高于以往各年; 2017年1—9月的自体输血总量相比2016年同期增加了39. 9%,其中贮存式自体输血量相比却减少了19. 2%,而术中自体输血量相比增加了53. 2%。结论借助信息系统开展术前自体输血评估流程,加强了输血科、麻醉科和临床科室三方之间的沟通,对自体输血的开展起到了积极的促进作用。     

心脏手术后纵隔流出血还输:成本效益分析

背景:在同种输血年度消耗总量中,心外科手术患者占有相当大的比重。自体血还输给患者也许是一种性能价格比较之同种输血划算的有效方案,而且,它还能够避免输血相关的副反应。方法:本研究调查了在亚拉巴马州大学医院作心脏手术的834例患者。收集的资料分别来自纵隔引流后未洗涤,经过滤后自体输血患者和同种输血患者。这些资料并入临床决断模式;用模拟样品统计学评估。参数的置信区间评估通过自举本统     

急诊自体血回输在创伤性血胸中的应用价值

目的探讨在急诊抢救创伤性血胸患者时胸腔血自体回输的方法及其应用价值。方法采用胸腔闭式引流术,将胸腔内血液引流并用一次性采血袋收集、再将血液回输。结果37例中34例经过使用上述方法后失血性休克得到纠正,生命体征平稳,获得了进一步治疗的时机。3例严重多发伤虽经积极抢救仍无法挽回生命。全部病例均未出现明显并发症。结论对中等量以上、无明显污染的胸腔血自体回输是一种安全、有效、经济、方便的方法,并能快速纠正失血性休克,为患者赢得抢救时机。     

应用腹腔镜穿刺鞘卡快速胸腔闭式引流术治疗大量气胸的临床效果观察

目的 探讨严重气胸快捷简单有效且适宜院前院内急救的治疗方法.方法 67例严重气胸患者随机分为观察组(34例)和对照组(33例).观察组采用腹腔镜穿刺鞘卡快速行胸腔闭式引流术,对照组采用传统大口径引流管及肋间常规切开方法行胸腔闭式引流术.分别观察2组手术时间、留管时间、住院时间、有效率以及术后疼痛、出血、皮下气肿、术后感染等并发症发生情况.结果 观察组与对照组总有效率[94.1%(32/34),90.9%(30/33),x2=1.876,P＞0.05]、留管时间[(4.56±1.65)d与(6.26±3.45)d,t=1.335,P＞0.05]、住院时间[(6.0±2.6)d与(6.7±2.2)d,t=0.779,P＞0.05]比较差异无统计学意义;但观察组在操作时间[(5.00±1.28)min与(15.00±4.03)min,t=3.031,P＜0.05],切口范围[(0.95±0.11)cm与(2.41±0.52)cm,t= 2.585,P＜0.05]方面少于对照组,差异有统计学意义;术后疼痛发生率[14.7%(5/34)与87.9%(29/33),t=2.983,P＜0.05]、出血发生率[0 与36%(12/33),x2=5.880,P＜0.05]、切口感染发生率[0与33%(11/33),t=3.687,P＜0.05]较对照组更少,差异有统计学意义.结论 应用腹腔镜穿刺鞘卡快速胸腔闭式引流术治疗气胸具有手术操作简单,易掌握,疗效可靠,并发症少等优点,适宜在院前院内急救中应用.

Abstract：

Objective To explore a rapid,simple and effective therapy for serious pneumothorax which could be used in pre-hospital and in-hospital first-aid.Methods Sixty-seven patients were randomly divided into the observation group and control group .Patients in the observation group were treated using laparoscopic trocar for rapidly closed thoracic drainage,and patients in the control group were treated by using the traditional large caliber drainage tube and the intercostal incision method of conventional closed thoracic drainage.The operation time,remaining time of drainage,length of stay,effective rate,and complications,including of postoperative pain,hemorrhage,subcutaneous emphysema and infection were observed in both groups. Results The total effective rate was 94.1%(32/34) in the observation group,which was significantly higher than that in the control group(90.9%,30/33)(x2=1.876,P＞0.05).No significant difference was found on the remaining time of drainage and length of stay between the two groups(remaining time of drainage:[4.56±1.65]d vs.[6.26±3.45]d;length of stay:(6.0±2.6)d vs.(6.7±2.2)d ,t=1.335 and 0.779,respectively,Ps＞0.05).The operation time of using laparoscopic trocar was significantly lower than that of the control group((5.00±1.28)min vs.(15.00±4.03)min,t=3.031,P＜0.05).The incision length was(0.95±0.11)cm in the observational group,which was significantly lower than that in the control group((2.41±0.52)cm ,t=2.585,P＜0.05).Postoperative pain occurred in 14.7%(5/34) of patients in the observational group,which was significantly lower than that in the control group(87.9%(29/33))(t=2.983,P＜0.05).In the observational group no hemorrhage and infection occurred,whereas in the control group the hemorrhage and infection rate was 36%(12/33) and 33%(11/33),respectively(x2=5.880 and 3.687,respectively,Ps＜0.05). Conclusion The use of laparoscopic trocar for rapidly closed thoracic drainage in the treatment of serious pneu-mothorax is simple,easy,convenient,effective and reliable,with few complications.This therapy is suitable for using in pre-hospital and in-hospital first-aid.     

基于疗养护理工作过程的急救训练模式探讨

目的积极探索疗养科室急救训练工作模式,提高疗养院护理应急救治训练水平和应急处置能力。方法改变单项急救技能训练考核的传统方法,模拟护理工作过程中的突发急诊病例及意外事件,根据医护排班模式组织医护联合同组训练方法进行急救整体过程的训练及考核。结果护士急救理论、操作技能成绩明显提高,抢救意识明显增强,医护配合更加默契、流畅,医护之间对抢救配合满意度提高。结论基于护理工作过程的急救训练模式是一种适合疗养科室急救训练的模式,对提高疗养院应急救治训练水平有着重要作用。     

急诊科心肺复苏医护配合的培训与管理

[目的]提高心肺复苏医护配合技术水平,提高抢救成功率,减少医患纠纷。[方法]根据急诊科人员结构成立医护配合心肺复苏技术培训小组,采取理论讲授和现场演练等训练模式,将自我训练与指导老师辅导相结合,并采取适当激励措施。[结果]在对心脏停搏病人进行医护配合心肺复苏技术抢救中,无一例病人家属因抢救因素引发纠纷。[结论]医护配合心肺复苏技术的培训能提高急救技术水平,减少医患纠纷的发生。     

Autotransfusion systems (ATS)

Due to the large number of patients undergoing cardiac surgical procedures and the subsequent increase in demand for blood volume replacement, the use of autotransfusion is increasing in the postoperative setting. In a study conducted by Roche and Stengel it was estimated that the country's blood resources could be depleted by these surgical procedures. The use of autotransfusion offers a viable solution for this problem. Studies suggest that with autotransfusion, bank blood requirements may decrease as much as 50 percent. The ready availability and economic advantages associated with autotransfusion may also ensure continued use of systems of this type. It has been the authors' experience thus far that both systems presented have been safe and effective when used in postoperative management of the cardiac surgical patient.     

自体输血对心脏直视手术围术早期的影响

目的通过对23例心脏直视瓣膜手术成年患采用自体输血的临床观察，并与输异体血患组进行对比．探讨术前血色素正常患进行不输血心脏直视手术对围水早期产生的影响和相应处理方法。方法自体输血组的23例患术中采用综合节血措施．包括术毕回输体外循环前经腔静脉营入的肝素血(15～20ml／kg)，术毕回输洗血球机清洗的手术刨口血血球和全部机血应用抑肽酶等：(1)自身对照比较患术前、术后返ICU及次晨的血红蛋白(Hb)、血小板(PLT)、白蛋白(ALB)、凝血酶原时间(PT)、纤维蛋白原(FIB）及动脉血氧分压(PaO2)的变化。(2)同时选择27例接受输异体血的瓣膜替换术患作为对照，比较两组间中心静脉压、血红蛋白、血小板及术后引流量等差异。结果自体输血组患术后Hb、PLT、AI．B、FIB均较术前降低(P<005)，PT显延长(P<0．05)；但Hh、PLT、FIB、PT仍在正常范围，ALB经补充后也能达到正常下限，Pa02水后较术前显升高。与对照组相比．实验组患术后Hb、PLT、引流量、术后晶体和蛋白输用量并无统计学显差异，而术中失血量、用库血量积术后代血浆用量却有明显差异。结论采用自体输血的心脏直视手术。围术期虽有轻度贫血但不影响血液的携氧功能，术后出凝血状况也不受影响。自体输血的影响主要集中在洗血球机回收刨VA失血同时也造成血浆丢失．加上不可控失血．造成术后围术早期血容量与血中白蛋白的变化，术后需补充适量代血装或人血白蛋白。     

控制性降压联合自体血回输在特发性脊柱侧弯矫形中的应用

背景:特发性脊柱侧凸是青少年较为常见的脊柱畸形,手术矫形是其重要的治疗手段.但手术创伤大、时间长,矫形过程中暴露、剥离组织较多,出血量大,需较大量的输血.为缓解血源紧张,减少输血费用,避免输血性疾病的发生,尽量减少输注异体库存血.目的:观察控制性降压联合自体血回输在特发性脊柱侧弯矫形中的作用.方法:对46例特发性脊柱侧弯患者行后路矫形时均进行术中控制性降压.其中17例未进行自体血回输,作为对照组,矫形后全部输异体库存血;另外29例均使用自体血液回输,包括矫形前预存自体血及矫形过程中自体血回输,作为实验组.观察两组患者失血量及输血情况.结果与结论:失血量:对照组400～1 000 (867±161) mL,实验组350～1400 (842± 376) mL,两组相比差异无显著性意义(P > 0.05).输入库存血量:对照组500～1 800 (845±332) mL,明显多于实验组0～1 300 (423±237) mL(P < 0.01).提示控制性降压可减少矫形过程中出血量,同时矫形后采用自体血回输可明显减少异体库存血的需要量.     

Effects on complement activation of a new continuous autotransfusion system

Allogeneic blood transfusions may subject patients to risks of infection and allergic reactions. Various techniques for transfusion of shed blood have been developed. The aim of this study was to evaluate a new continuous autotransfusion system (Fresenius CATS^®) as regards its impact on the complement system, and on erythrocytes and leucocytes. Eighteen consecutive patients undergoing hip replacement surgery were studied. Complement variables (C4d, factor Bb, C3a and terminal complement complex, SC5b-9) and free haemoglobin, haemoglobin, leucocytes, platelets, albumin and protein were determined in the patient's blood preoperatively, 1 min before the start of transfusion, 15 and 60 min after transfusion; and in the reservoir, in the waste bag and in the retransfusion blood. Increased concentrations of C3a and SC5b-9 were found in the collected reservoir blood ( P  < 0.05). The washing and centrifugation procedure reduced these concentrations (< 0.001). High levels of free haemoglobin were found in the collected blood as well as in the processed product. The median haemoglobin level in the processed blood was 260 g L⁻¹ (range 104–289 g L⁻¹). Inflammatory mediators from the complement cascade are removed by continuous autotransfusion technique. The processed blood contains high levels of free haemoglobin.     

急诊护上急救技能能级评价体系的构建与应用

目的：构建急诊护士急救技能能级评价体系,完善急诊护士的技能评价工作。方法：综合运用文献法、系统分析法、Delphi（德尔菲）法、AHP（层次分析）法等科学研究方法,构建急诊护士急救技能能级评价体系,并对我院64名急诊护士的急救技能现状进行实测分析。结果：构建了涵盖4个能级共80项具体评价指标的急诊护士急救技能能级评价体系,并经检验证实该体系科学、合理、实用,具有应用价值。结论：急诊护士急救技能能级评价体系适合对急诊护士的急救技能进行全面评价,为护理人力资源的有效管理提供了依据。     

An evaluation of clinical aspects of post-operative autotransfusion, either alone or in conjunction with pre-operative aspirin, in cardiac surgery.

Two groups of 21 otherwise healthy patients undergoing coronary artery bypass grafting (CABG) for the first time were studied in order to evaluate the advantages and disadvantages of post-operative autotransfusion using a red cell 'salvage' method. Group 1 patients (control group) were transfused using donor blood only. Group 2 patients were transfused with their own (autologous) blood, salvaged post-operatively, although donor blood was also available to them if needed. The two groups were further subdivided according to whether the patients received aspirin pre-operatively or not. The four subgroups thus formed were comparable pre- as well as intra-operatively, with respect to all available clinical and laboratory criteria. The post-operative data, however, showed that the combination of pre-operative aspirin and autotransfusion leads to excessive post-operative bleeding, together with increased donor blood requirement. It was also shown that autotransfusion without aspirin does reduce the need for donor blood transfusion without any increase in post-operative bleeding. Although aspirin alone did not increase post-operative bleeding or donor blood requirement, its combination with autotransfusion should be avoided.