血液回收在脊柱侧弯矫正术中的应用价值

脊柱侧弯为小儿及青少年的常见病 ,行手术矫正内固定治疗时创伤非常大 ,出血很多。本文旨在探讨血液回收技术在脊柱侧弯矫正术中的应用价值。资料与方法一般资料　脊柱侧弯矫正ＴＳＲＨ内固定术患者 40例 ,ＡＳＡ为Ⅰ～Ⅱ级 ,年龄为 8～ 16岁 ,男 2 2例 ,女 18例 ,平均体重 45 6ｋｇ。方法　将 40例患者随机分为两组 ,每组 2 0例。术前均查血常规及出凝血时间。Ａ组 (对照组 ) :红细胞压积 (Ｈｃｔ)低于 0 30时输库血 ;Ｂ组 (血液回收组 ) :采用血液回收技术 ,利用ＣＯＢＥＢＲＡＴ2 血液回收系统将创面渗血吸引至血液回收机 ,在吸引的同…     

围术期自体输血综合措施在骨科手术中的应用

目的：观察骨科重大手术围术围术期综合应用自体血回输措施的适用价值。方法：20例骨科重大手术,包括脊柱侧弯矫治术,髋,膝关节置换术等。均于全麻后手术前行急性等容血液稀释（ANH）,采血200－400ml,术中使用洗涤式血液回收机回收术野出血,以洗涤红细胞的形式回输,术后除脊椎侧弯矫治术外,其余病例均回收手术创面引流血经过滤后回输,结果：除3例脊 侧弯矫治术术中输入库血外,其他病例均可做到不输库血,ANH期间血液动力学稳定,术中自体血回收后以洗涤红细胞回输及术后创面引流血回输,均未见输血并发症。结论：应用ANH,术中自体血及术后引流回收的综合措施可有效地减少输入库血。     

急性高容性血液稀释联合自体血回收回输技术在全髋关节置换手术中的应用及对患者的影响

目的评价急性高容性血液稀释和自体血回收回输技术联合应用对全髋关节置换手术的血液保护效果及其安全性。方法 2010年9月至2012年3月在本组实施全髋关节置换手术、预计出血量〉600ml的120例患者随机分为四组,每组30例：对照组、急性高容性血液稀释组、自体血回输组、急性高容性血液稀释组＋自体血回收回输组。术中、术后对血流动力学指标、凝血功能进行检测,记录术中失血量、输血量,麻醉时间和手术时间,以及评价并发症。结果采用自体回输血技术的患者中约50%患者不用再输异体血,其中自体血回输组未输异体血的比例46.67%、急性高容性血液稀释组＋自体血回收回输组未输异体血比例为60%,而对照组中仅10%的患者不需输入异体血,单纯AHH组为1/3患者未输异体血。与对照组相比,所有采用血液保护措施的患者异体输血量比对照组约少240ml,自体血回输技术的再回收率约为40%;术中、术后各组血流动力学指标和凝血功能指标无明显差异,均保持维持稳定;各种组均未发现与应用血液保护技术有关的并发症。结论联合应用急性高容性血液稀释和自体血回收回输技术,可以明显减少失血量、降低异体输血,对患者影响小,并发症低,对全髋关节置换手术来说是一种安全有效的血液保护技术,值得推广应用。     

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。     

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术中自体血液回输技术早在1925年就开始用于开颅手术病人，其后不断有人探讨其在临床实践中的应用价值。20世纪60年代以后，随着麻醉和外科技术的发展，许多高难度、高风险尤其是出血量多的手术得以大量开展，加之特殊血型病人供血稀缺，库存血已无法满足如此大的供血需求。1974年，美国Haemonetics公司研制的Cell Saver血液回收装置问世后，自体血液回输在手术中的应用便不断增加，其相对于异体输血的优势得以显现。它可以避免或减少术中异体输血，解决血源紧张和术中自体血流失造成的浪费问题，还可以防止因异体输血而引起的病毒性肝炎、艾滋病等传染性疾病和过敏反应、移植物抗宿主反应、溶血等异体免疫反应。然而，其在肿瘤手术中的应用一直存在争议，肿瘤手术甚至成为自体血液回输的一个禁忌。争议的焦点在于，手术中被恶性肿瘤细胞污染的血液经过自体血液回输装置处理后是否可能将肿瘤细胞再回输给病人从而引起肿瘤的复发或播散。本文就自体血液回输在肿瘤手术中的应用现状及进展做一综述。     

自体血回输在严重多发骨折手术中的应用

目的探讨自体血回输在严重多发骨折手术中的应用及意义。方法针对45例严重多发骨折行内固定手术的患者,术中采用自体血回输技术,观察自体血回输安全性和实用性。术中平均出血1034ml,收集红细胞液的压积平均为50%的自体血回输。结果术中平均回输红细胞压积50%自体血673ml,无输血反应及过敏反应发生,明显减少异体库血需要量。结论术中自体血回输在多发骨折手术中的应用是安全可靠的,有临床应用价值。     

外科手术中血液回收55例

目的总结55例外科手术中自体血液回收的经验.方法应用国产BW-8100A型自体血液回收机,对55例手术患者手术区的出血回收,经清洗、浓缩处理后再回输.结果55例共回收出血94 640 mL,获浓缩红细胞35250 mL.2例因出血量大于2000 mL输异体红细胞和血浆,其余患者均未使用异体血.结论自体血液回收机的临床应用,减少了输异体血,避免了感染的发生,提高了抢救成功率.     

自体血液回收机在大出血手术中的应用

目的:通过对大出血病人应用自体血液回收机在术中回收回输血液技术的方法、减少异体血的输入,降低血源性传染病的传播。方法:选择12例术前评估病人手术创伤大、出血多、RH阴性、无污染、无癌症的病人。应用自体血液回收机把手术中或创伤中丢失的血液收集起来(从切皮到缝合),经肝素化过滤去除杂质,再用生理盐水洗涤和浓缩得到压积30～40％浓缩的红细胞,边回收边回输给病人。结果:12病人,术中共回收自体血10380ml,全组病人除1例因产后羊水栓塞伴DIC抢救无效死亡外,其他术中、术后未输异体血,无发热、出血、及溶血反应的发生,回输后病人体温、心率、血压稳定,无术后并发症。结论:应用血液回收对大出血病人急需输血又缺乏相溶血型时,无须检验血型和交叉配血,为抢救赢得时间,对于RH阴性病人自体血回输解决了难以配型的问题。有效减少了库血用量,降低了血源性传染病的传播机会,避免了输异体血的不良反应和血源浪费,对急性大出血病人,节约了异体血配型所需的时间。     

心脏直视手术自体血回输和异体血输注对比研究

目的探讨在心脏直视手术中采用自体血回输的临床效果。方法将2002年进行心脏直视手术的患者作为观察组,采取综合自身输血措施,包括回输体外循环前经腔静脉放的肝素血,应用美国AOTOLOG自身血液回收机回收患者切口创面的血液,回输剩余机血、应用抑肽酶等。1998年进行心脏直视手术的患者作为对照组,体外循环前不放血、不进行血液回收、也不回收剩余机血,根据术中失血量输注库血。比较两组患者手术前后的出凝血状况、Hb的变化、术中失血量、术后引流量、用异体血量及术后并发症等情况。结果两组之间相比,术前与术后24小时HB、PLT、PT、术中失血量等方面差异无显著性(P>0.05);而术后引流量、输注异体血量对照组均大于观察组(P<0.01)。术后并发症对照组明显高于观察组P<0.01。结论对心脏直视手术患者采取自身输血措施,可明显减少输异体血量、术后引流量及术后并发症的发生率。     

自体血回输技术在脑外伤手术患者中的应用

目的探讨回收式自体血回输在脑外伤手术中的应用效果。方法本院2012年1月至2013年12月,实施脑外伤手术,选择无自体血回输禁忌症且预计出血量大于600ml的90例患者随机分成两组,每组45例：对照组A组、术中回收式自体血回输组（研究组）B组,对患者手术前（T1）、手术结束（T2）、术后24小时（T3）患者的凝血功能及红细胞（RBC）、血红蛋白（HGB）、红细胞压积（Hct）进行检测,记录输血量,以及评价并发症。结果应用回收式自体血回输组48%的患者避免了术中、术后异体血的输入,而对照组仅9%的患者不需输入异体血。以对照组相比,自体血回输患者异体输血量平均每例比对照组少输293ml,自体血回输再回收率约49%,各组术前、手术结束、术后24小时血液中的RBC、Hb、Hct及凝血功能检测数据大致正常。结论自体血液回输用以脑外伤患者是安全且有效的方法,可以及时获得大量新鲜血液对患者进行抢救,同时节省异体血用量,并且可以避免血液传播性疾病的发生,对患者影响小、并发症低,可安全应用于脑外伤手术。     

The Effect of epsilon-aminocaproic acid on perioperative blood loss in patients with idiopathic scoliosis undergoing posterior spinal fusion: a preliminary prospective study.

STUDY DESIGN: A prospective study evaluating the efficacy of epsilon-aminocaproic acid (EACA) in decreasing perioperative blood loss in idiopathic scoliosis. OBJECTIVES: To compare the perioperative blood loss and need for blood replacement in two groups of patients undergoing surgery for idiopathic scoliosis. One group received intraoperative EACA; the other did not and served as controls. SUMMARY OF BACKGROUND DATA: Excessive blood loss increases the operative time, risk for blood product disease transmission, postoperative complications, and costs associated with posterior spinal fusion and instrumentation. EACA is an antifibrinolytic agent that has been shown to be effective in reducing perioperative blood loss during pediatric cardiothoracic surgical procedures. We hypothesized that it would also be effective in lowering blood loss during posterior spinal fusion for idiopathic scoliosis. METHODS: We compared the perioperative blood loss of 28 consecutive pediatric patients with idiopathic scoliosis who underwent posterior spinal fusion and received intraoperative EACA with 31 consecutive patients who did not receive this medication and served as a control group. RESULTS: The patients in both groups were similar. Patients in the EACA group demonstrated statistically significant decreases in total estimated perioperative blood loss and the need for autologous blood transfusion. The patients in the EACA group had no intraoperative or postoperative complications related to the use of this medication. CONCLUSIONS: Based on these preliminary findings, we believe that EACA is helpful in decreasing blood loss in patients undergoing posterior spinal fusion and instrumentation, and may decrease the number of autologous units needed to maintain safe perioperative hemoglobin levels, thereby improving safety and lowering cost associated with scoliosis surgery.     

自体血小板分离联合术中自体血回输在脊柱侧弯矫形术中的价值

目的探讨自体血小板分离联合术中自体血回输技术在脊柱侧弯矫形术中的临床价值。方法 60例行脊柱侧弯手术患者随机分为三组,每组20例。Ⅰ组:术前自体血小板分离并制备富血小板血浆（PRP）,术中自体血回收,手术结束前回输PRP;Ⅱ组:仅行术中自体血回收,未进行自体血小板分离回输;Ⅲ组:未进行血液保护措施。测定Ⅰ组手动提取PRP中血小板计数（Plt）,于麻醉诱导前（T₁）、自体血小板分离后10 min（T₂）、输自体回收血及PRP前10 min（T₃）、输自体回收血及PRP后10 min（T₄）、术后24 h（T₅）、术后48 h（T₆）各时点测Hb水平、凝血功能、Plt和血小板聚集功能;比较手术时间、术中出血量、术后24、48 h切口总引流量、术中及术后48 h异体血输入量。结果三组手术时间、术中出血量差异无统计学意义;T₃、T₄时三组Plt和血小板聚集功能明显低于T₁时（P<0.01）。与Ⅰ组比较,T₅、T₆时Ⅱ、Ⅲ组凝血功能、血小板聚集功能显著降低（P<0.05）,术后24、48 h切口总引流量明显增加（P<0.01）,术中及术后48 h内输异体血总量明显增加（P<0.01）。结论自体血小板分离联合术中自体血回输可显著改善脊柱侧弯矫形术患者术后血小板聚集及凝血功能,减少术后切口引流量及异体血输注量。     

Posterior spinal fusion in adolescent idiopathic scoliosis with or without intraoperative cell salvage system: a retrospective comparison

This study investigates efficacy and safety of routine cell salvage system use in adolescent idiopathic scoliosis patients undergoing primary posterior spinal fusion surgery with segmental spinal instrumentation. Forty-five consecutive adolescent idiopathic scoliosis patients undergoing posterior spinal fusion by two surgeons at a single hospital were studied. Intraoperative cell salvage system was used in 23 patients, and the control group was 22 patients who underwent surgery without cell salvage system. The cell salvage system was the Haemonetics Cell Saver 5. The primary outcome measures were intraoperative and perioperative allogeneic transfusion rate, difference between preoperative and discharge Hg and Hct levels. Average patient age was 14.65 ± 1.49 in cell saver group and 13.86 ± 2.0 in control group. In cell saver group, average intraoperative autotransfusion was 382.1 ± 175 ml. Average perioperative allogeneic blood transfusion need was 1.04 ± 0.7 unit in cell saver group and 2.5 ± 1.14 unit in control group. No transfusion reactions occurred in either group. Average hemoglobin level in cell saver group was 10.7 ± 0.86 and average hemoglobin level in control group was 10.7 ± 0.82 on discharge. Cell saver reduces perioperative transfusion rate in patients undergoing posterior spinal fusion for adolescent idiopathic scoliosis.     

The use of autologous blood in the surgical treatment of spinal disorders.

A program of autologous blood transfusion in 101 patients who underwent spinal surgery was analyzed. Autologous transfusion was achieved by intraoperative blood salvage using a cell saver and with predeposited blood. The techniques of predeposition of blood included freezing the blood and using a storage solution. Forty-eight patients had scoliosis and received mainly cryopreserved autologous blood and 53 patients had other spinal diseases. Surgery was performed using only autologous blood transfusion in more than 90% of all patients cases. The program was well tolerated by the patients and easily managed by the blood center staff. There were no severe complications associated with this program. The use of instrumentation and extensive spinal fusion were found to be factors associated with increased intraoperative blood loss. This finding suggests that instrumentation surgery and extensive spinal fusion are indications for autologous blood transfusion. Cryopreserved autologous blood transfusion is an effective method for storing a sufficient volume of blood for scoliosis surgery without affecting the patients' preoperative hemodynamic status.     

Homologous blood transfusion is not required in surgery for adolescent idiopathic scoliosis

We studied 70 consecutive patients with adolescent idiopathic scoliosis who underwent corrective surgery. They were divided into two groups. In the study group of 38 patients one or more modern blood-conservation measures was used peri-operatively. The 32 patients in the control group did not have these measures. Both groups were similar in regard to age, body-weight, the number of levels fused and the type of surgery. Only two patients in the study group were transfused with homologous blood and these transfusions were 'off-protocol'. Wastage of autologous pre-donated units was minimal (6 of 83 units). By contrast, all patients in the control group were transfused with homologous blood. In the study group there was a significant decrease (p = 0.005) in the estimated blood loss when all the blood-conservation methods were used. The use of blood-conservation measures, the lowering of the haemoglobin trigger for transfusion and the education of the entire team involved in the care of the patient can prevent the need for homologous blood transfusion in patients undergoing surgery for adolescent idiopathic scoliosis.     

Segmental spinal instrumentation in idiopathic scoliosis. A preliminary report

Eighty-six patients with idiopathic scoliosis who underwent a posterior spinal fusion using sublaminar segmental spinal instrumentation were analyzed retrospectively. There were two operative groups: group 1, 66 patients who had Harrington rod instrumentation and segmental wiring, and group 2, 20 patients who had Luque rod instrumentation. The clinical and radiographic data of the two groups were similar except for the passage of more sublaminar wires and increased intraoperative blood loss in group 2. Twenty intraoperative or postoperative complications occurred in 19 patients (22%) including 14 neurologic complications. Three patients (3%) had major spinal cord injuries, while 11 patients (13%) had transient sensory changes. There was no significant difference in the incidence of neurologic complications between group 1 or group 2. The remaining intraoperative complications were due either to anesthesia, positioning during surgery, or technique (dural tear). Late complications occurred in two patients in group 1 only: one each with rod breakage and hook displacement. Only one patient (1%) has required additional surgery. Our results indicate that although segmental instrumentation can be beneficial in idiopathic scoliosis, the incidence of complications, primarily neurologic, will be higher than expected. The major reason appears to be surgeon inexperience with passage of sublaminar wires. As experience increases, the incidence of complications declines and becomes comparable with conventional Harrington rod instrumentation alone.     

Comparison of single- and dual-rod techniques for posterior spinal instrumentation in the treatment of adolescent idiopathic scoliosis

STUDY DESIGN: Two groups of patients undergoing posterior spinal instrumentation and arthrodesis for treatment of adolescent idiopathic scoliosis were reviewed retrospectively. OBJECTIVE: To compare intraoperative concerns (operative time and blood loss), complications, and outcome in patients undergoing single or double posterior rod instrumentation for treatment of adolescent idiopathic scoliosis. SUMMARY OF BACKGROUND DATA: The current treatment of idiopathic scoliosis includes posterior spinal instrumentation and arthrodesis. The standard configuration is a rectangular construct of dual rods connected by cross-links. Use of a single rod with multiple fixation points has been proposed as an alternative method to decrease operative time and blood loss, and to avoid late deep infections. METHODS: In this study, 21 patients underwent posterior instrumentation using a standard dual-rod construct, and 25 patients underwent posterior instrumentation using a solitary rod with multiple fixation points. Patients were assessed after a minimum 2-year follow-up period. RESULTS: No significant differences were found in blood loss, operative time, or overall frequency of long-term complications. Although not statistically significant, the trend was toward implant prominence in the double-rod group and implant failure in the single-rod group. Implant failure occurred only in instrumentations extending into the lumbar spine. There was no statistical difference in curve progression. CONCLUSIONS: Single-rod instrumentation and dual-rod constructs offered similar curve correction, blood loss, and operative time. However, single-rod instrumentation may be more prone to implant failure when extended into the lumbar spine.     

The effect of tranexamic acid in blood loss and transfusion volume in adolescent idiopathic scoliosis surgery: a single-surgeon experience

Purpose

Intraoperative blood loss in scoliosis surgery often requires transfusions. Autogenous blood decreases but does not eliminate risks typically associated with allogenic blood transfusion. Costs associated with transfusions are significant. Tranexamic acid (TXA) has been shown to decrease blood loss in cardiac and joint surgery. Few studies have examined its use in pediatric spine surgery, and the results are inconsistent. The aim of this study was to determine whether TXA decreases intraoperative blood loss and transfusion requirements in adolescent idiopathic scoliosis patients undergoing posterior spinal fusion by a single surgeon.

Methods

The medical records and operative reports of surgically treated patients with adolescent idiopathic scoliosis between 2000 and 2009 were retrospectively reviewed. The inclusion criteria were: (1) patients who underwent instrumented posterior spinal fusion, (2) had complete medical records, and (3) were treated by the same surgeon. Forty-nine patients who met the inclusion criteria were divided into two groups: Group A (25 patients) received TXA, while Group B (24 patients) did not receive TXA.

Results

After controlling for age at the time of surgery, gender, and number of vertebral levels fused, the mean intraoperative blood loss was significantly lower in Group A (537 ml) than in Group B (1,245 ml) (p = 0.027). The mean volume of blood transfused intraoperatively was 426 and 740 ml for Group A and Group B, respectively. The difference was not statistically significant after controlling for age, gender, and number of levels fused (p = 0.078).

Conclusion

TXA significantly decreased intraoperative blood loss in posterior spinal fusions performed for adolescent idiopathic scoliosis.     

The use of fibrin sealant to reduce blood loss during Cotrel-Dubousset instrumentation for idiopathic scoliosis

The increased complexity of Cotrel-Dubousset instrumentation has, as an unexpected side effect, a potential increase in blood loss. A prospective randomized study was undertaken to test the hypothesis that application of a fibrin sealant to exposed cancellous bone can significantly reduce blood loss during Cotrel-Dubousset instrumentation for idiopathic scoliosis. A significant difference was demonstrated in total body loss, loss per level fused, and loss per kilogram of body weight when comparing the sealant group with random controls. A significant difference was demonstrated in loss per level fused when comparing the sealant control with a historical control group. Thirty-three patients were randomly assigned to the fibrin sealant or nonsealant groups; another 10 patients operated on before planning the study were included as historical controls. The sealant was used to control bleeding at the bone graft donor site and in the spine after decortication. All patients underwent Cotrel-Dubousset instrumentation for idiopathic scoliosis. There were no significant differences between groups with respect to degree of curvature, number of levels fused, age or weight of patient, or operating time. Total blood loss in the sealant group averaged 672 ml compared with 894 ml in the sealant control group. No patient in the sealant group required homologous blood. Given the increasing awareness of the complications of blood transfusion, the authors conclude that fibrin sealant is a useful adjunct to spinal surgical technique.