术中自体血回输在脊柱外科手术中的应用及其并发症

目的 探讨术中自体血回输在脊柱外科手术中的应用及并发症.方法 应用国产自体-3000P型血液回输机对115例脊柱手术术中失血进行回输.结果 115例脊柱外科手术回输浓缩红细胞75 900 ml,平均每人术中出血(1250±862)ml,回输自体血(670±445)ml,异体输血(520±212)ml.除1例并发凝血功能障碍外,无输血及免疫调节反应,无术后感染.结论 术中自体血回输能减少脊柱手术异体血用量,并发症少,使用安全有效.     

预存自体输血在脊柱侧凸矫形术中的应用

目的：探讨预存自体输血在脊柱侧凸矫形术中应用的可行性。方法：选择９６例行后路器械矫形融合术的脊柱侧凸患者,５０例患者接受了预存自体输血。作为研究员,另４６例患者除术前未行预存自体输血外,其它条件如年龄、手术方式、手术时间等与研究组相似,作为对照组。所有患者术中均常规使用自体血回输。结果：预存自体输血组平均预存血量为６５０ｍｌ,围手术期异体血输入量平均为３５０ｍｌ。对照组围手术期异体血平均输入量为８     

等容量血液稀释自体输血法在脊柱及全骨关节置换术中的应用

异体输血存在血源传播疾病与血源不足两个问题。为避免或减少输血并发症，术前采用等容量血液稀释自体血输血法是良好的措施。本文在脊柱及全体关节置换术中选用等容量血液稀释自体输血法，报道如下。     

回收式自体输血在脊柱前路稳定手术中的应用

目的 讨论通过回收式自体输血在脊柱前路减压内固定手术中的应用,提高手术的安全性,减少用血量。方法 在19例脊柱胸腰段骨折患者进行前路减压髂骨植骨椎体钉内固定时,采用回收式自体输血（洗涤式）,减少异体血使用。同时回顾20例同组手术医师同种手术患者的输血量做对照。结果 19例（进口设备16例,国产设备3例）平均回输浓聚红细胞536ml,其中2例补充少量异体血。对照组输异体血947ml,明显多于回收式自体输血者（P＜0．05）。结论 在行胸腰段脊柱前路稳定手术中,采用回收式自体输血,可以明显减少输血量,有利于提高手术安全性,降低医疗费用。尤其是利用国产设备进行自体回收输血,成本低廉,操作简便,宜于推广。     

自体输血在骨科手术中的应用

目的：骨科择期手术用自体血输血替代延用已久的异体血输血术,减少输血后合并症,加速患者康复。方法：采血前1周口服铁剂、维生素C等药物。术前第12d及第5d分2次采血,总量800ml。在无菌条件下分离出富含血小板血浆及浓缩红细胞,在相对应条件下储存备用。结果：38例输自体血,26例输异体血,输自体血者一般情况恢复快,输注效果优于输异体血者。结论：在骨科手术中,采用自体输血术优于输异体血。     

血液稀释法自体输血在脊柱侧凸后路手术中的应用

目的：探讨在脊柱侧凸矫形术中应用血液稀释法自体输血的可行性。方法：３６例脊柱侧凸患者在行后路器械矫形融合术中采用了血液稀释法自体输血。２０例患者术接受了预存自体输血,其中４例患者又应用了术中自体血回输。结果：平均轴血量为６２７ｍｌ（４２５～８３４ｍｌ）,血液稀释后红细胞压积达２９．８％。２０例平均预存血量为６５０ｍｌ。术中术后平均总失血量１８５０ｍｌ,平均异体血输入量７５０ｍｌ。４例应用术中自体血回输患者均未输异体血而安全度过手术期。所有患者在血液稀释采血后血红蛋白、红细胞压积均明显下降,术后１周基本恢复正常,未发现应用血液稀释法采血的相关并发症。结论：血液稀释法自体输血能有效减少异体血的输入量,且安全有效、节约区费;联合应用多种自体输血方法可大大减少甚至无需异体血输入。     

最大限度自体输血在心脏手术中的应用观察

本文旨在探讨术中自体输血对心瓣膜直视手术的影响。资料与方法一般资料　 6 0例行首次瓣膜置换术的风湿性心脏瓣膜病人 ,年龄 14～ 6 0岁 ,Ｈｃｔ≥ 34 % ,Ｐｔｓ >11× 10 9/Ｌ ,ＥＦ >2 5 % ,无肾衰、心肌梗塞、脑血管疾病及出凝血性疾病史。随机分成两组 :Ａ组不行自体输血     

自体血回收复合控制性降压麻醉对脊柱大手术凝血功能的影响

随着脊柱外科的发展，失血量较多的脊柱大手术开展得越来越多，从而导致对血液的需求量日益增多。但目前血源比较紧张，且异体输血可传播多种疾病和发生多种并发症。而自体血液回输的应用可以较少临床输血。同时控制性降压也广泛应用于脊柱大手术的麻醉。作者从2005年6月至2006年6月，采用自体血回收复合控制性降压麻醉用于脊柱大手术20例，     

预存自体输血在全髋关节置换手术中的应用

目的：探讨全髋关节置换手术减少异体输血的措施，介绍一种较理想的自体输血方法。方法：自1997年12月－2001年1月，对80例全髋关节置换手术患者进行了预存自体输血。采血前、后前4d检测血红蛋白（HGB），红细胞（RBC），红细胞压积（HCT），结果：预存自体血23700ml,平均409ml，58例（72．5％）患者无需异体输血顺利度过围手术期，22例（27．5％）患者补充异体输血7392ml，平均336ml，而同期未做预存自体输血者输异体血69741ml，平均567ml，没有发生与预存自体输血相关的并发症。结论：预存自体输血简便，经济、安全、有效，全髋关节置换手术患者基本上依靠预存自体输血能安全度过围手术期。     

回收式自体输血在骨科手术中的应用

目的 探讨自体血回输在骨科手术中的应用。方法应用全自动血液回收机，收集手术野出血，经处理后回输给患者。结果应用自体血回收，使75．8％的患者避免了术中、术后异体血的输入，术后血液检测及凝血功能指标正常。结论自体血回输可使需输血的骨科手术患者避免了异体输血带来的潜在危险，节约了血资源。     

Autologous blood transfusion for combined plastic surgeries

Autologous blood transfusion is indicated and helpful for any patient who is entering surgery in whom the surgeon anticipates a large blood loss because of the multiple or combined plastic operations being planned for one surgical sitting. The advantages of autologous over homologous transfusions include avoidance of incompatibility reactions, better volume expansion, and no risk of acquiring diseases.     

Autologous blood transfusion in total knee replacement surgery

We compared allogeneic blood usage for two groups of patientsundergoing total knee replacement surgery (TKR). Patients wererandomized to receive either their post-operative wound drainageas an autotransfusion (n=115) after processing or to have thiswound drainage discarded (n=116). Allogeneic blood was transfusedin patients of either group whose haemoglobin fell below 9 gdl^–1. Only 7% of patients in the autotransfusion grouprequired an allogeneic transfusion compared with 28% in thecontrol group (P<0.001). There was no hospital mortalityand only 3% mortality from all causes at the study completion,which spanned 6 months to 3 yr. There was a higher incidenceof infection requiring intervention in the allogeneic group(P<0.036). Total patient costs were £113 greater inthe autotransfusion group. We conclude that in this type ofsurgery post-operative cell salvage is a safe and effectivemethod for reducing allogeneic blood use. Br J Anaesth 2001; 86: 669–73     

控制性降压联合自体血回输在脊柱手术中的应用

目的 探讨控制性降压联合自体血回输技术应用于复杂脊柱外科大手术的临床效果及安全性. 方法 将40例脊柱外科大手术的患者用抽签法随机分为两组(每组20例):控制性降压联合自体血回输组(A组)和非自体血回输组(B组).A组全麻诱导后,术中用硝酸甘油行控制性降压,维持平均动脉压(mean arterial pressure,MAP)(65±5) mmHg(1mmHg=0.133 kPa),并用血液回输仪回收术野出血;B组未行自体血回输;两组术中血细胞比容(hematocrit,Hct)低于25％即输库血.两组术中连续监测心率(heart rate,HR)、MAP、心电图(electrocardiogram,ECG)和中心静脉压(central venous pressure,CVP).记录两组患者术中出血量、异体输血量及输血相关并发症,术前和术后24 h红细胞(red blood cell,RBC)、血红蛋白(hemoglobin,Hb)、Hct、血小板(platelet,PLT)及凝血酶原时间(prothrombintime,PT)、活化部分凝血酶原时间(activeated partial thromboplasting time,APTT)和纤维蛋白原(fibrinogen,FG). 结果 A组出血量(1 120±510) ml与B组(1 524±457) ml比较,差异有统计学意义(P＜0.05);A组输异体血发生率(10％)显著少于B组(100％)(P＜0.01);术后24 h两组患者RBC、Hb、Hct、PLT、PT、APTT和FG与术前比较差异有统计学意义(P＜0.05),但都在正常范围内,两组间比较差异无统计学意义(P＞0.05);两组均无肺水肿、心力衰竭及创面异常出血并发症. 结论 控制性降压复合术中自体血回输在复杂脊柱手术中的应用是安全可靠的,能明显减少出血量,减少甚至避免异体血输入.     

Perioperative hemodilutional autologous blood transfusion in burn surgery

It is important to avoid or minimise allogeneic blood transfusion, because of possible alloimmunisation or disease transmission. In burn cases these risks are high, and predonated autologous transfusion is not practical. Perioperative haemodilutional autologous blood transfusion is considered applicable in burn surgery. This study evaluates the effectiveness of the technique in the treatment of burns.     

骨科手术中自体血液回输对血清前炎性细胞因子浓度的影响

目的 测定下肢骨科手术术野回收血经自体血回收机处理前后及患者自血回输前后血清前炎性细胞因子浓度,观察骨科手术中自体血回输对患者细胞免疫的影响.方法 30例择期行下肢骨科手术患者,分别采集自体血回收机处理前后的术野回收血,并于自体血回输前10min、回输后1 h采集患者动脉血,采用放射酶联免疫吸附测量法测定血样中3种前炎性细胞因子白细胞介素(IL)-1β、IL-6、肿瘤坏死因子(TNF)浓度,并观察相关并发症.结果　术野回收血经自体血回收机处理前后3种前炎性细胞因子IL-1β、IL-6、TNF浓度分别为(0.54 ±0.22)、(0.71±0.16)、(16.23±5.68)μg/L和(0.26±0.12)、(0.29±0.09)、(6.32±2.57)μg/L,与处理前比较,处理后3种细胞因子浓度显著降低(P＜0.05);自血回输前后患者血清中3种细胞因子IL-1β、IL-6、TNF浓度分别为(0.35±0.17)、(0.47±0.15)、(8.44±3.56)μg/L和(0.39±0.19)、(0.52±0.18)、(9.48±3.45)μg/L,与回输前比较,回输后患者血清中3种细胞因子浓度增高(P＜0.05);30例患者自体血回输后12 h内均未观察到低血压、心动过速、血红蛋白尿、凝血功能紊乱、脓毒血症、空气栓塞、心肺问题等并发症.结论　骨科手术患者术中可适量自体血回输,回收血液经自体血回收机处理后前炎性细胞因子浓度显著降低,回输后未观察到严重并发症.

Abstract：

Objective To investigate the effects of autologous blood transfusion on serum cytokine levels in patients undergoing lower limb orthopedic surgery. Methods A total of 30 cases scheduled for undergoing lower limb orthopedic surgery were enrolled in this study. Each patient had four blood samples taken (pre-transfusion, one h post-transfusion, cell saver container, and post-filtration from the blood bag). An enzyme linked immunosorbent assay (ELISA) measurement of radiation was conducted to determine levels of the cytokines interleukin (IL)-1β, IL-6 and tumor necrosis factor (TNF). Serious complications and sequelae associated with autotransfusion were recorded. Results In comparison to cell saver container, levels of IL-1β, IL-6 and TNF in the blood bag were decreased significantly (P＜0. 05 ). In comparison to pre-transfusion, levels of IL-1β, IL-6 and TNF were increased significantly (P ＜ 0. 05 ). No serious complications and sequelae associated with autotransfusion were observed. Conclusion The use of cell saver container appears to be safe in patients undergoing orthopedic surgery and the levels of the cytokines in post-filtration blood are decreased.     

Risk analysis of blood transfusion requirements in emergency and elective spinal surgery

Spinal surgery has long been considered to have an elevated risk of perioperative blood loss with significant associated blood transfusion requirements. However, a great variability exists in the blood loss and transfusion requirements of differing patients and differing procedures in the area of spinal surgery. We performed a retrospective study of all patients undergoing spinal surgery who required a transfusion ≥1 U of red blood cells (RBC) at the National Spinal Injuries Unit (NSIU) at the Mater Misericordiae University Hospital over a 10-year period. The purpose of this study was to identify risk factors associated with significant perioperative transfusion allowing the early recognition of patients at greatest risk, and to improve existing transfusion practices allowing safer, more appropriate blood product allocation. 1,596 surgical procedures were performed at the NSIU over a 10-year period. 25.9% (414/1,596) of these cases required a blood transfusion (n = 414). Surgical groups with a significant risk of requiring a transfusion >2 U RBC included deformity surgery (RR = 3.351, 95% CI 1.123–10.006, p = 0.03), tumor surgery (RR = 3.298, 95% CI 1.078–10.089, p = 0.036), and trauma surgery (RR = 2.444, 95% CI 1.183–5.050, p = 0.036). Multivariable logistic regression analysis identified multilevel surgery (>3 levels) as a significant risk of requiring a transfusion >2 U RBC (RR = 4.682, 95% CI 2.654–8.261, p < 0.0001). Several risk factors in the spinal surgery patient were identified as corresponding to significant transfusion requirements. A greater awareness of the risk factors associated with transfusion is required in order to optimize patient management.     

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目的 观察老年人术前储存式自体输血的临床效果。方法 自决定放行储存式自体输血之日起,入选病例每天口服多糖铁１５０ｍｇ,每日２次,采血前１小时控予采血量的３倍给予晶、胶液体（晶、胶液体量比例为２：１）经外周静脉输入,然后经另一侧静脉采血,每次采血４００ｍｌ,同隔７２小时采血１次,部采血量不应超过１２００ｍｌ。结果 除２例病人因术中失血量过多同时输注异体血外,其余病人均未用异体血,其余病人均未恢复良好     

回收式自体输血与异体输血对机体炎症反应的影响

背景 自体血回输在围术期应用日益广泛.自体血和异体血输注均会对机体的炎症反应产生一定的影响.目的 对两种输血方式后机体炎症因子的变化进行对比,阐述围术期两种输血方式对患者的影响. 内容 异体血在输注过程中产生大量炎症因子,如白细胞介素(interleukin,IL)-2、IL-6、IL-8、IL-10、肿瘤坏死因子-α(tumor necrosis factor-α,TNF-α)等,引起机体炎症反应,可能是术后并发症的重要原因.自体血在回收、过滤的过程中同样会产生一定量的炎症因子. 趋向 对骨科自体血及异体血应用进行对比,研究两种输血方式对机体炎症反应的影响.     

肝移植术麻醉中自体血液回输技术的应用

目的 探讨肝移植术中应用自体血液同输技术的安伞性和效果.方法 选择行原化肝移植术患者46例,根据是否符合自体血回输标准分为两组:回输组和对照组,每组23例.回输组术中应用自体血液回收机进行血液收集、回输,观察其效果.分别于麻醉前、无肝前期、无肝期、新肝期、术毕等时点采血样,测定红细胞汁数(RBC)、血红蛋白(Hb)、血小板(Plt)、血细胞比容(Hct)、凝血酶原时间(PT)、活化部分凝血酶时间(APTT)、纤维蛋白原含量(FIB)及国际标准化比值(INR).结果 回输组每例回输自体血(2 613±1 637)ml,输入异体浓缩红细胞量显著少于对照组(P＜0.01),两组间各时点RBC、Hb,Plt、Hct、PT、APTT、FIB、INR差异无统计学意义.结论 肝移植术中应用自体血液叫输技术能及时回收失血,维持有效循环,显著减少异体血输入.