回收式自体输血与异体输血对心脏手术患者凝血功能及血液流变学指标的影响

目的 观察回收式自体输血与异体输血对心脏手术患者凝血功能及血液流变学的影响。方法 回顾性分析,采集我院2019年6月至2022年1月期间收治的心脏手术患者的基线资料,异体组（45例,异体血回输）,回收组（45例,回收式自体输血）,对比两组凝血功能、血液流变学及不良反应。结果 回收组输血后1 d、5 d活化部分凝血活酶时间（APTT）、凝血酶原时间（PT）、D-二聚体（D-D）表达低于异体组,纤维蛋白原（FIB）高于异体组（P<0.05）;输血后1 d,异体组高切全血黏度（HSBV）、低切全血黏度（LSBV）、全血黏度及血细胞比容均下降（P<0.05）,回收组HSBV、LSBV、红细胞聚集指数（EAI）、全血黏度及血细胞比容下降（P>0.05）;回收组总发生率低于异体组（P<0.05）。结论 回收式自体输血对心脏手术患者凝血功能及血液流变学影响均较小,且安全可靠。     

心内直视术中胸血回收式自体输血研究进展

胸血回收式自体输血（ATS）是将患者术中、术后胸腔出血或外伤胸腔积血回收处理后再回输。近年来心内直视术的广泛开展和日趋紧张的血源，使胸血ATS越来越受到重视。现将近年来的研究进展综述如下。     

稀释及回收式自体输血在良性脑肿瘤手术中的应用

目的 探讨稀释及回收式自体输血在良性脑肿瘤手术中的应用效果.方法 选取择期行颅脑手术的126例良性脑肿瘤患者作为研究对象,采用非随机、同期对照研究方法及患者自愿原则将其分为稀释及回收式自体输血组65例和异体输血组61例;前者采用稀释及回收式自体输血,后者采用异体输血.比较两组血液电解质、免疫功能指标以及输血不良反应和术...     

洗涤回收式自体输血对老年多脏器联合伤患者细胞免疫的影响

目的探讨洗涤回收式自体输血对老年多脏器联合伤患者细胞免疫产生的影响。方法多脏器联合损伤的老年患者76例,随机分成对照组和观察组各38例。其中对照组采用异体输血,观察组采用洗涤回收式自体输血。结果术后3、10 d,观察组T淋巴细胞亚群CD3+、CD4+、CD8+与自然杀伤(NK)细胞水平与对照组比较差异具有统计学意义(P0.01)。术后3、10 d,观察组免疫球蛋白(Ig)G、Ig M、补体(C3)水平与对照组比较差异具有统计学意义(P0.01)。结论洗涤回收式自体输血对患者细胞免疫功能的影响较小,患者预后好。     

回收式自体输血在腹部大出血术中的临床应用

目的：探讨回收式自体输血的安全性和效果。方法：将回收式自体输血技术应用于腹部大出血手术的临床实践中,观察回收血液后患者的重要功能指标变化情况,包括外周血红细胞、血红蛋白、血细胞比容、血小板数、凝血酶原时间、活化部分凝血活酶时间、纤维蛋白原和肝功能指标丙氨酸氨基转移酶、碱性磷酸酶、肾功能指标尿素氮、尿酸、肌酐及不良反应。结果：血液各项指标和肝肾功能正常,主要成分指标差异无统计学意义,不良反应少。结论：回收式自体输血操作简单方便,经血液回收机处理后的自体血安全可靠,有一定的临床推广价值。     

异体输血对消化道出血患者凝血功能及部分免疫功能的影响

[目的]探讨异体输血对消化道出血患者凝血功能及部分免疫功能的影响。[方法]入选消化性溃疡出血、血红蛋白65~75g/L的患者40例,其中不给予输血治疗20例作为对照组,给予输注少白红细胞2~4U的20例作为输血组,并分别于输血组的输血前、输血后采取2组患者静脉血,检测其凝血功能及外周血中自然杀伤(NK)细胞、IgG、IgA、IgM、CD3~+、CD4~+、CD8~+、CD4~+/CD8~+的变化情况。[结果]输血组输血前与对照组各项指标均无显著差异,输血后NK细胞、CD3~+、CD4~+、CD4~+/CD8~+、IgG较输血前显著减少(P0.05),IgA、IgM与输血前变化不显著;输血组输血前、输血后1d凝血功能指标变化均差异不显著(P0.05)。[结论]异体输血对纠正患者失血性贫血有疗效,但对患者免疫功能抑制明显,对于异体输血量在一定范围内的患者凝血功能无明显影响。     

贮存式自体输血开展对优化妇科手术用血结构的影响

目的:总结本院2011-2013年贮存式自体输血开展前后,妇科手术用血异体少白细胞红细胞和自身贮血的应用情况。方法:对本院妇科手术台次,异体少白细胞红细胞及贮存式自体血液的使用人数、量及比例分别进行统计。结果:最近3年妇科手术台次逐年上升,异体少白细胞红细胞用量从463.5U下降至320.5U,自体输血量上升至161U。异体输血比例由手术人次的33.61%下降至19.80%,自体输血比例由0上升至22.61%。人均异体少白细胞红细胞使用量由0.783U下降至0.450U,人均自体全血用量由0上升至0.226U。结论:贮存式自体输血开展,使妇科手术用血结构得到优化,其对临床节约用血的影响,得到了规模性,量化体现。     

临床血液回收和血液保存对老年人红细胞免疫功能的影响

目的临床探讨血液回收和血液保存对老年人红细胞免疫功能的影响。方法选择临床血液回收的手术患者100例。患者术中回收的红细胞为Ⅰ组；Ⅰ组患者的术野红细胞100份为Ⅱ组；库存2w的浓缩红细胞100份为Ⅲ组。分别测定三组红细胞的受体花环形成率、免疫复合物花环形成率、CD35阳性红细胞百分率及红细胞超氧化物歧化酶水平。结果Ⅰ组与Ⅲ组红细胞受体花环形成率、CD35阳性红细胞的百分率及红细胞超氧化物歧化酶水平均低于Ⅱ组，且Ⅰ组上述指标均高于Ⅲ组（P〈0．05或0．01）。三组红细胞免疲复合物花环形成率比较差异无统计学意义（P〉0.05）。结论血液回收可在一定程度上损害红细胞的免疫功能，但术中回收红细胞的免疫功能优于库存2w的红细胞。     

体外循环术中自体血回收对血液成分及凝血功能的影响

目的观察体外循环术中不同自体血回收方式对患者血液成分及凝血功能的影响。方法随机将60例体外循环下心脏手术的成人患者分为A、B两组,均为30例。A组为观察组,全部术野出血用自体血液回收机离心洗涤后于手术结束前回输体内。B组为对照组,不采用自体血液回收机,将肝素化后的术野出血直接吸回体外循环系统停机前回输体内,鱼精蛋白拮抗后机器余血打入输血袋,于手术结束前静脉回输。对两组患者麻醉前、体外循环中及术毕静脉血进行血常规及凝血四项指标的测定,记录停机后两组激活凝血时间（ACT）及术后24h内胸腔引流量和输注异体血用量,并对以上观察结果进行比较分析。结果①观察组患者术后24h内胸腔引流量及异体血用量明显少于对照组,差异有统计学意义（P〈0．05）。②与术前相比,两组患者血红蛋白（Hb）、红细胞比容（Hct）和血小板（PLT）均明显下降,凝血酶原时间（PT）、活化部分凝血活酶时间（APTT）和凝血酶时间（TT）明显延长,但两组间比较差异无统计学意义。③术毕观察组Hb和Hct值较体外循环中明显回升,且与对照组相比差异有统计学意义,但仍略低于术前。④两组术毕PLT、PT、APTT和TT均明显低于术前,但仍在正常范围内,两组间差异无统计学意义。结论体外循环期间自体血回收对患者血液成分及凝血功能的影响不明显,是一种有效的血液保护方法。     

冠状动脉搭桥手术中自体血液回收对红细胞流变性的影响

目的 :观察非体外循环冠状动脉搭桥术中自体血液回收对红细胞流变性的影响。方法 :随机将 4 8例冠状动脉搭桥术患者分为 2组 (洗涤组、非洗涤组 ) ,对 2组不同时间点进行流变学特性观察。结果 :实验组洗涤前较术前及洗涤后血液流变学特性明显下降 ;洗涤后与术前相比无明显差异 ;2组术前、术后 3h无差异。结论 :自体血液回收过程使红细胞聚集性增加 ,变形性下降 ,但通过洗涤后血液流变学特性逐步恢复 ,输入洗涤后自体血液 ,对机体整体血液流变学特性无明显负面影响。     

Autologous blood salvage in the era of patient blood management

Almost 150 years after the first autologous blood transfusion was reported, intraoperative blood salvage has become an important method of blood conservation. The primary goal of autologous transfusion is to reduce or avoid allogeneic red blood cell transfusion and the associated risks and costs. Autologous salvaged blood does not result in immunological challenge and its consequences, provides a higher quality red blood cell that has not been subjected to the adverse effects of blood storage, and can be more cost‐effective than allogeneic blood when used for carefully selected surgical patients. Cardiac, orthopaedic and vascular surgery procedures with large anticipated blood loss can clearly benefit from the use of cell salvage. There are safety concerns in cases with gross bacterial contamination. There are theoretical safety concerns in obstetrical and cancer surgery; however, careful cell washing as well as leucoreduction filters makes for a safer autologous transfusion in these circumstances. Further studies are needed to determine whether oncologic outcomes are impacted by transfusing salvaged blood during cancer surgery. In this new era of patient blood management, where multimodal methods of reducing dependence on allogeneic blood are becoming commonplace, autologous blood salvage remains a valuable tool for perioperative blood conservation. Future studies will be needed to best determine how and when cell salvage should be utilized along with newer blood conservation measures.     

术中自体血回输在神经外科手术中的应用分析

目的:了解术中自体血回输在神经外科手术中的实际应用情况和临床效果分析。方法:对2012年神经外科手术中132例自体血回输患者的回收量,回输量,异体血输注量,及手术前后Hb,Hct等指标进行回顾性分析。结果:术中共回收自体血146 200ml,平均每例回收1 107.6ml;共回输自体血83 290ml,平均每例回输630.9ml。其中43例除自体血回输外,还分别输注了数量不等的红细胞和血浆。患者均未发生输血反应。患者术前术后的血常规变化差异无统计学意义。结论:术中自体血回输在神经外科手术中的应用能明显减少异体血输注量,节约血资源,并能减少或避免输血反应的发生。     

The use of cord blood for transfusion purposes: current status

Although the use of umbilical cord blood (UCB) for transfusion purposes has been proposed decades ago, the employ is still limited. In this article we review studies evaluating UCB collection efficiency and sterility, examine processing and storage of UCB-derived red blood cells (RBC) and discuss clinical studies in which UCB was used for transfusion purposes.
Efforts to provide preterm newborns with autologous RBC derived from UCB have not been very successful. UCB collected after full-term deliveries can however easily be processed into RBC products and could be used autologous in case surgery of the neonate is indicated early after birth, or for allogeneic small volume paediatric transfusions. To harvest enough UCB volume, immediate clamping of the umbilical cord is commonly used as standard practice. Although delayed cord clamping has shown to improve the iron status in full-term infants; for small-for-gestational-age infants this has not been demonstrated. In addition, an increased need for phototherapy after delayed clamping exists. Altogether, we could find no disencouraging evidence to collect UCB, which could be processed into an easily available RBC product for paediatric transfusion in resource-restricted countries.     

Indications and organisational methods for autologous blood transfusion procedures in Italy: results of a national survey

Introduction

Pre-operative donation of autologous blood is a practice that is now being abandoned. Alternative methods of transfusing autologous blood, other than predeposited blood, do however play a role in limiting the need for transfusion of allogeneic blood. This survey of autologous blood transfusion practices, promoted by the Italian Society of Transfusion Medicine and Immunohaematology more than 2 years after the publication of national recommendations on the subject, was intended to acquire information on the indications for predeposit in Italy and on some organisational aspects of the alternative techniques of autotransfusion.

Materials and methods

A structured questionnaire consisting of 22 questions on the indications and organisational methods of autologous blood transfusion was made available on a web platform from 15 January to 15 March, 2013. The 232 Transfusion Services in Italy were invited by e-mail to complete the online survey.

Results

Of the 232 transfusion structures contacted, 160 (69%) responded to the survey, with the response rate decreasing from the North towards the South and the Islands. The use of predeposit has decreased considerably in Italy and about 50% of the units collected are discarded because of lack of use. Alternative techniques (acute isovolaemic haemodilution and peri-operative blood salvage) are used at different frequencies across the country.

Discussion

The data collected in this survey can be considered representative of national practice; they show that the already very limited indications for predeposit autologous blood transfusion must be adhered to even more scrupulously, also to avoid the notable waste of resources due to unused units.Users of alternative autotransfusion techniques must be involved in order to gain a full picture of the degree of use of such techniques; multidisciplinary agreement on the indications for their use is essential in order for these indications to have an effective role in “patient blood management” programmes.     

Comparison of results of autologous versus homologous blood transfusion in open-heart surgery

Background

The aim of this study was to determine a method to decrease the use of homologous blood during openheart surgery using a simple blood-conservation protocol. We removed autologous blood from the patient before bypass and used isovolumetric substitution. We present the results of this protocol on morbidity and mortality of surgery patients from two distinct time periods.

Methods

Patients from the two surgical phases were enrolled in this retrospective study in order to compare the outcomes using autologous or homologous blood in open-heart surgery. A total of 323 patients were included in the study. The autologous transfusion group (group 1) comprised 163 patients and the homologous transfusion group (group 2) 160 patients. In group 1, autologous bloods were prepared via a central venous catheter that was inserted into the right internal jugular vein in all patients, using the isovolumetric replacement technique. The primary outcome was postoperative in-hospital mortality and mortality at 30 days. Secondary outcomes included the length of stay in hospital and in intensive care unit (ICU), time for extubation, re-intubations, pulmonary infections, pneumothorax, pleural effusions, atrial fibrillation, other arrhythmias, renal disease, allergic reactions, mediastinitis and sternal dehiscence, need for inotropic support, and low cardiac-output syndrome (LCOS).

Results

The mean ages of patients in groups 1 and 2 were 64.2 ± 10.3 and 61.5 ± 11.6 years, respectively. Thirty-eight of the patients in group 1 and 30 in group 2 were female. There was no in-hospital or 30-day mortality in either group. The mean extubation time, and ICU and hospital stays were significantly shorter in group 1. Furthermore, postoperative drainage amounts were less in group 1. There were significantly fewer patients with postoperative pulmonary complications, pneumonia, atrial fibrillation and renal disease. The number of patients who needed postoperative inotropic support and those with low cardiac output was also significantly less in group 1.

Conclusion

Autologous blood transfusion is a safe and effective method in carefully selected patients undergoing cardiac surgery. It not only prevents transfusion-related co-morbidities and complications but also enables early extubation time and shorter ICU and hospital stay. Furthermore, it reduces the cost of surgery.     

Anaemia and red blood cell transfusion in the critically ill patient

Anaemia is a common finding in critically ill patients. There are often multiple causes. Obvious causes include surgical bleeding and gastrointestinal haemorrhage but many patients have no overt bleeding episodes. Phlebotomy can be a significant source of blood loss. In addition, critically ill patients have impaired erythropoiesis as a consequence of blunted erythropoietin production and direct inhibitory effects of inflammatory cytokines. The ability of a patient to tolerate anaemia depends on their clinical condition and the presence of any significant co-morbidity; maintenance of circulating volume is of paramount importance. There is no universal transfusion trigger. Current guidelines for critically ill and perioperative patients advise that at Hb values <70 g/L red blood cell transfusion is strongly indicated and at Hb values >100 g/L transfusion is unjustified. For patients with Hb values in the range 70 to 100 g/L the transfusion trigger should be based on clinical indicators. Most stable critically ill patients can probably be managed with a Hb concentration between 70 and 90 g/L. Uncertainties exist concerning the most appropriate Hb concentration for patients with significant cardio-respiratory disease.     

自体血液回收机在小儿脊柱矫形手术中的应用体会

目的探讨自体血液回收机在小儿脊柱矫形手术中应用的意义。方法将396例脊柱侧弯患儿分为两组,实验组为应用血液回收机自体输血者217例,对照组未应用血液回收机而输异体血179例。比较两组术中出血量、输血量及手术前后血红蛋白（Hb）值。结果两组术中出血量及手术前后Hb值无统计学差异（P〉0.05）;实验组输异体血量明显少于对照组（P〈0.05）。结论自体血液回收机的使用明显减少了异体血的输入,在小儿脊柱矫形手术中应用很有价值。     

医院输血科在输血质量管理中的实践探讨

<正>临床输血医学的迅速发展,给我们带来严峻的挑战!即如何保证输血质量,确保输血安全[1]。对拥有650张病床,年用血量6 000U的二等甲级综合医院的输血科来说,如何管理、提高输血质量是我们的工作重点。下面是我科近几年里实践探索和积累的部分经验,现报告如下。1积极开展创建活动,参加室间质评,提高输血质量2011年我院输血科申报了创建湖北省临床输血重点专科[2],参加了湖北省临检中心室间质量控制,从参加室间质控以来,每次质评(ABO正定型;