血液回收机在外科手术中的应用

血液回收机是一种先进的医疗设备。它利用机械吸引装置对病人因手术而流失的血液进行收集,然后对血液进行分离、清洗、净化、选择,再回输给病人。在手术过程中,病人可不再或减少输注异体血。这不但能节约用血,而且还可避免输异体血带来的危害。我科从2000年4月至11月期间,有45例手术使用自体-2000型血液回收机进行血液回收,取得了良好效果,报道如下。 1 临床资料 本组45例,男36例,女9例,年龄23～56岁。其中异体肝移植19例,异体心脏移植1例,异体心肾移植1例,动脉导管结扎2例,主动脉瓣置换1例,脊柱手术10例、骨盆手术1例,     

自体血液回输在复杂髋臼骨折内固定术中应用

观察自体血液回输在复杂髋臼骨折内固定术大出血中的应用的评价．     

自体血液回输在复杂髋臼骨折内固定术中应用

观察自体血液回输在复杂髋臼骨折内固定术大出血中的应用的评价.     

自体引流血回输的临床应用

输血可分为异体输血和自体输血两种.异体输血越来越多的副作用引起了人们的恐慌,特别是经血液传播的各种病毒性肝炎、梅毒、艾滋病等等.因而人们在输异体血的同时,寻找并发现了一种更安全的输血方式-自体输血.     

52例大血管手术中的自体血液回收应用分析

目的探讨自体血液回收（ICS）技术在大血管外科手术中的应用效果。方法回顾性分析2011年52例大血管病外科手术。自体血液回收（ICS）技术在大血管外科手术中的应用,其中StanfordA型夹层动脉瘤17例,Marfan综合征10例,升主动脉瘤15例,腹主动脉瘤6例,先天性主动脉缩窄或主动脉弓离断4例。所有患者术中全程使用ICS系统,记录回收术中失血量及洗涤红细胞（WRBC）量,随机检测WRBC与库存悬浮红细胞（BRBC）的血气及活化凝血时间（ACT）,统计各类患者围术期用血量并与2010年同类病例进行比较。结果全组病例回收术中失血、渗血612-10058mL,平均3199mL,获得WRBC130-1645mL,平均647mL;各类大血管患者回收失血量、WRBC量比较相差不显著（P〉0．05）;WRBC与BRBC血气比较相差显著（P〈0．01）,ACT值无统计学差异（P〉0．05）;与2010年同类患者相比较减少40％异体血输入量（P〈0．05）。结论大血管外科手术中应用ICS系统具有良好的临床效果,是节约用血、减少库血输入的可靠方法,可常规使用。     

术前预存血回输在骨科择期手术中的应用

随着外科技术的发展，大中型骨科手术的开展日益广泛。本院自2000年开始，在骨科择期手术中采用术前预存血回输技术，有效减少了同种异体间输血的用量及并发症的发生。     

术中自体血液回收系统中应用国产一次性血液回收贮存器的效果评价

目的 评价自体血液回收系统中使用国产一次性血液回收贮存器在手术中的安全性和有效性.方法 选取2014年4月至2015年3月我院外科手术患者80例,进行术中自体血液回输.根据使用一次性血液回收贮存器的不同,随机分为两组:实验组使用国产一次性血液回收贮存器(罐体组件和双管组件)、配合进口自体血液回收机和离心杯套装,对照组使用进口一次性血液回收贮存器及其配套自体血液回收机和配套耗材.观察两组患者自体回收血液处理前后的血常规、游离血红蛋白浓度、血气等有效性指标;观察设备有无故障、患者有无不良反应等安全性指标.结果 实验组患者自体回收血液,经洗涤后红细胞压积大于50％,游离血红蛋白浓度小于300mg/L,清洗过程中能明显清除游离血红蛋白,白细胞、K+.实验组患者平均每例回收血液0.76L,经血液回收机处理后获得浓缩血液0.17L,均回输给患者.使用过程中设备未发生故障、病人无不良反应事件发生.结论 一次性国产血液回收贮存器性能可靠、使用安全,可满足临床使用需要.     

自体血液回输对成人心脏瓣膜置换术患者血液携氧功能的影响

目的 探讨自体血回输对体外循环下心瓣膜置换术患者血液携氧功能的影响。方法抽选河南省胸科医院心外科2014年4月—2016 年1月收治的90例首次接受心脏手术的心脏瓣膜病患者作为研究对象,随机分为观察组和对照组。观察组45例采用自体血液回收技术;对照组45例不采用自体血液回收技术,直接使用库血。检测并比较两组术前(T₁)、术毕(T₂)、术后24 h(T₃)、术后第7天(T₄)的动脉血液携氧功能指标,包括RBC、Hb、红细胞比容(Hct)、氧合指数、红细胞内2,3-二磷酸甘油酸浓度(2,3-DPG) 、红细胞变形指数(RCD)。结果 观察组与对照组在T₂时点的RBC分别为(3.59±0.37)×10¹²/L和(3.64±0.44)×10¹²/L,Hb分别为(101.26±19.54)g/L和(102.38±20.05)g/L,Hct分别为(0.35±0.12)和(0.34±0.13),较组内T₁降低,差异均有统计学意义(P值均＜0.05);但T₃和T₄与组内T₁时点比较,差异均无统计学意义(P值均>0.05),且组间各时点比较差异均无统计学意义(P值均>0.05)。观察组在T₁~T₄的氧合指数分别为(415.14±51.24)、(348.33±39.45)、(317.59±33.36)和(377.16±45.44) mmHg(1 mmHg=0.133 kPa),对照组则分别为(418.16±52.18)、(344.44±42.20)、(320.65±35.11)和(375.24±43.94) mmHg,组间各时点比较差异均无统计学意义(P值均>0.05),但组内术后各时点与术前比较差异均有统计学意义(P值均＜0.01)。两组间及组内术前术后红细胞2,3-DPG比较差异均无统计学意义(P值均>0.05)。两组RCD术后较术前的有明显增高(P值均＜0.01),而组间比较差异均无统计学意义(P值均>0.05)。结论 应用自体血液回输对成人心脏瓣膜置换术中血液携氧功能无明显损伤,可减少库血的使用,具有较高的临床意义。     

青少年脊柱侧弯后路矫形手术围术期异体输血的危险因素

目的 了解青少年脊柱侧弯(AS)后路矫形术围术期异体红细胞(RBC)输注率及其危险因素。方法 本研究为回顾性队列研究。收集2015年1月至2017年5月在北京协和医院行脊柱侧弯后路矫形手术的青少年的围术期临床资料。根据围术期是否接受异体输血,将患者分为异体输血组和非输血组,比较两组的临床特征。采用二分类Logistic回归分析其异体输血的危险因素。结果 469例患者纳入研究,其围术期异体输血率为30.5%,危险因素为校正体质量指数(BMI)(OR=0.887, 95%CI:0.815～0.966,P<0.01)、其他类型(相比于特发性)脊柱侧弯(OR=3.847, 95%CI:1.660～8.917,P<0.01)、术前贫血(OR=6.322, 95%CI:2.053～19.473,P<0.01)、手术节段>12.5个(OR=3.554, 95%CI:2.174～5.885,P<0.001)、术前Cobb角>64.5°(OR=2.381, 95%CI:1.356～4.178,P<0.01)和截骨手术(OR=7.551, 95%CI:3.258～...     

回收式自体输血在脊柱外科手术中的应用

自体输血应用越来越广泛。大中型脊柱外科手术的出血量常常多达600-2000ml，输血已成为脊柱手术的必需手段之一。现就我科脊柱外科手术应用回收式自体输血的经验总结如下。     

洗涤式自体血回输对心脏手术患者凝血和携氧功能的影响

目的:观察洗涤式自体血回输对心脏手术患者凝血功能和红细胞携氧功能相关指标的影响。方法:61例手术患者采用美国美敦力血液回输机进行洗涤式自体血回输,分别测定术前、术后当天、术后第1天、术后第7天血液凝固指标:血小板计数(PLT)、血浆凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、凝血酶时间(TT)、纤维蛋白原(FIB)、D-二聚体(D-D)和红细胞携氧功能相关指标:血氧分压(PaO2)、血氧饱和度(SaO2)、血酸碱度(pH)、红细胞计数(RBC)、血红蛋白含量(HGB)、红细胞压积(Hct)。结果:61例患者术中回收原血和"机血"共84912ml,平均每例患者回输浓缩红细胞465ml。与术前比较,术后当天和术后第1天凝血功能指标PLT、FIB显著降低(P<0.01),PT显著延长(P<0.05或P<0.01),术后当天D-D明显升高(P<0.05);携氧功能指标PaO2在术后当天和术后第1天显著升高(P<0.01),RBC、HGB、Hct均显著降低(P<0.01,P<0.05)。术后第7天所有异常指标均恢复至术前水平。结论:洗涤式自体血回输不影响血液凝固和携氧功能,可安全应用于心脏手术。     

献血者差异性对红细胞质量影响的研究

临床输注红细胞的质量和安全性有着严格的监管控制。尽管如此,红细胞质量的差异仍然存在,其中的主要原因可能是由于献血者的差异性所致,但在目前输血相关的临床研究中,与献血者有关的差异性对红细胞质量的影响仍不明确。现将献血者差异性对红细胞质量影响的研究进展进行综述。     

临床输血病历质量调查分析

调查医院输血病历存在的问题,分析不合理原因,提高临床输血质量。方法 以《病历书写基本规范》《医疗机构临床输血管理办法》《临床输血技术规范》《医院输血管理检查评分表》为依据,随机抽查我院2017年1月~12月临床用血科室的466份输血病历,对输血有关记录的完整性、输血适应证、输血不良反应进行分析。结果 共抽取病历466份,其中手术科室224份,非手术科室242份;手术科室与非手术科室输血相关记录不合格率相比较,差异有统计学意义（P＜0.05）,以输血治疗同意书记录缺陷为主;非手术科室输血合理率（93.80%）高于手术科室（89.73%）,但差异无统计学意义（P＞0.05）。结论 部分临床医生对输血病历质量的重要性认识不足,医院应加强对临床输血病历质量的检查、分析和改进,加强医务人员输血知识的培训,不断提高临床输血的科学性和规范性。     

The Efficacy,Safety and Cost-Effectiveness of Intra-Operative Cell Salvage in High-Bleeding-Risk Cardiac Surgery with Cardiopulmonary Bypass: A Prospective Randomized and Controlled Trial

Objective: Intra-operative cell salvage (CS) was reported to be ineffective, safe and not cost-effective in low-bleeding-risk cardiac surgery with cardiopulmonary bypass (CPB), but studies in high-bleeding-risk cardiac surgery are limited. The objective of this study is to evaluate the efficacy, safety and cost-effectiveness of intra-operative CS in high-bleeding-risk cardiac surgery with CPB.Methods: One hundred and fifty patients were randomly assigned to either with intra-operative CS group (Group CS) or without intra-operative CS group (Group C). Study endpoints were defined as perioperative allogeneic red blood cell (RBC) transfusion, perioperative impairment of blood coagulative function, postoperative adverse events and costs of transfusion-related.Results: Both the proportion and quantity of perioperative allogeneic RBC transfusion were significantly lower in Group CS than that in Group C (p=0.0002, <0.0001, respectively). The incidence of residual heparin and total impairment of blood coagulative function in the 24 hours after surgery, the incidence of postoperative excessive bleeding, were significantly higher in Group CS than that in Group C (p=0.018, 0.042, 0.034, respectively). Cost of both allogeneic RBC transfusion and total allogeneic blood transfusion were significantly lower in Group CS than that in Group C (p<0.001, =0.002, respectively). Cost of total blood transfusion was significantly higher in Group CS than that in Group C (p =0.001).Conclusion: Intra-operative CS in high-bleeding-risk cardiac surgery with CPB is effective, generally safe, and cost-effective in developed countries but not in China.     

受血者输血中Rh血型E抗原对患者机能免疫功能影响

目的 探讨受血者输血中Rh血型E抗原对患者机能免疫功能影响.方法 收集2014年3月至2016年7月200组受-供血者的血标本,其中100组受-供血者E抗原均呈阴性为A组,另100组受血者E抗原呈阴性、供血者E抗原呈阳性为B组.受血者输血前后分别检测血清白细胞介素-2(IL-2)、免疫球蛋白M(IgM)、IgG抗体及血中T淋巴细胞亚群(CD4+、CD8+).结果 A组输血前后血清IL-2、IgM及IgG抗体水平均无明显变化.B组输血后IL-2、IgM及IgG抗体水平均呈先逐渐升高,后逐渐降低的过程,均在输血后5d达到最高,在输血后18d基本恢复至输血前水平.B组输血后3、5、10d IL-2、IgM及IgG抗体水平均明显高于A组(P均＜0.05);A组输血前后血清CD4+、CD8+细胞数无明显变化.B组输血后CD4+细胞数均呈先逐渐升高后降低,CD8+细胞逐渐降低后升高,均在输血后3d达到最高和最低,在输血后18d基本恢复至输血前水平;B组输血后5、10d CD4+细胞数均明显高于A组,CD8+细胞低于A组(P均＜0.05).结论 Rh(E)抗原阴性的受血者在输注E抗原阳性血制品后,其机能免疫功能将出现有时间限制的改变;临床应加强对受-供血者的Rh(E)抗体的检测,配型满意后方进行输血,提高临床输血的科学性、合理性与安全性.     

Blood supply system in Mexico

Mexico with a population of 112 million in 32 federal states, has made  great progresses in the lasts years in regulation, access and security of blood and components; actually the challenge is to reverse the reposition to voluntary blood donation system. The blood system counts with 555 blood banks and 4,342 transfusion services. 25% of the blood banks belong to the Ministry of Health, 15% to the Mexican Social Security Institute (IMSS) and 10% to the Institute of Security and Social Services for State Workers (ISSSTE), the blood banks of the Ministry of Defense, Navy and “Petroleos Mexicanos” constitute only 3% and more than 40% are private. Only 31 of them collect more than 10,000 units/year, 64 have an annually average collection between 10,000 and 5,000 and 101 collect over 2,000 and less than 5,000; 70% of the blood banks participated in the external quality control program. In 2011 the total country collection was 1,698,124 blood units, with an average increase of 50,000/year. PAHO’s rate of blood donors for every 10,000 inhabitants in Mexico is 148, indicating self-sufficiency, but only 2·38% is obtained from voluntary blood donors. The IMSS collects more than 40% of the blood in country; but 99·7% is obtained by replacement donors. The frequency of transfusion transmission infectious diseases in blood donors was for HIV 0·31%, HBV 0·20%, HCV 0·60%, syphilis 0·47%, Chagas’s disease 0·46% and brucellosis 0·39%. The analyzed results highlight the need to promote voluntary blood donation, regionalization of blood services and to increase the participation in external quality programs in order to reduce the risks associated to blood transfusions in Mexico. The Ministry of Health promotes voluntary blood donations through external collects in universities, enterprises and embassies obtaining good responds. The “National Policy of Use of Blood and Blood Components” from 1993, was reviewed and updated including a mandatory establishment of a quality system based in GMP′s, participation in external quality programs, voluntary blood donation promotion, evaluation of the performance services information and hemovigilance reports.     

不同抗凝剂自体血回输对输卵管妊娠破裂患者炎症因子的影响

目的 探讨采用不同抗凝剂进行自体血回输的临床实用性和对输卵管妊娠破裂患者的炎症因子的影响。方法 选取我院2014年1月~2015年8月收治的输卵管妊娠破裂出血患者60例,随机分为H组和C组,每组30例。H组行肝素抗凝剂,C组行枸橼酸钠抗凝剂,收集术野失血进行自体血回输,检测回输后两组患者TNF-α、IL-6、IL-8、IL-10的变化。结果 两组患者TNF-α在T3和T6时与T1相比明显升高,IL-6、IL-8在T3、T4、T5是逐渐升高,T6时回落,IL-10在T2后持续升高直至T6,存在统计学意义（P<0.01）。与H组比较,C组IL-6、IL-8和IL-10在T3、T4、T5、T6时浓度明显低于H组,存在统计学意义（P<0.01）。结论 与肝素组比较,枸橼酸钠组自体血回输后体内炎症因子释放较少, 但操作繁琐、不安全,临床实用性低于肝素组。     

Individual Quality Assessment of Autografting by Probability Estimation for Clinical Endpoints: A Prospective Validation Study from the European Group for Blood and Marrow Transplantation

The aim of supportive autografting is to reduce the side effects from stem cell transplantation and avoid procedure-related health disadvantages for patients at the lowest possible cost and resource expenditure. Economic evaluation of health care is becoming increasingly important. We report clinical and laboratory data collected from 397 consecutive adult patients (173 non-Hodgkin lymphoma, 30 Hodgkin lymphoma, 160 multiple myeloma, 7 autoimmune diseases, and 28 acute leukemia) who underwent their first autologous peripheral blood stem cell transplantation (PBSCT). We considered primary endpoints evaluating health economic efficacy (eg, antibiotic administration, transfusion of blood components, and time in hospital), secondary endpoints evaluating toxicity (in accordance with Common Toxicity Criteria), and tertiary endpoints evaluating safety (ie, the risk of regimen-related death or disease progression within the first year after PBSCT). A time-dependent grading of efficacy is proposed with day 21 for multiple myeloma and day 25 for the other disease categories (depending on the length of the conditioning regimen) as the acceptable maximum time in hospital, which together with antibiotics, antifungal, or transfusion therapy delineates four groups: favorable (≤7 days on antibiotics and no transfusions; ≤21 [25] days in hospital), intermediate (from 7 to 10 days on antibiotics and <3 transfusions, ≤21 to 25 days in hospital or ≥7 days on antibiotics and no transfusions; from 21 to 30 days [25 to 34] in hospital), unfavorable (>7 days on antibiotics, >3 but <6 transfusions; >30/34 days in hospital after transplantation), and very unfavorable (>10 days on antibiotics, >6 transfusions; >30 to 34 days in hospital). The multivariate analysis showed that (1) PBSC harvests of ≥4 × 10⁶/kg CD34 + cells in 1 apheresis procedure were associated with a favorable outcome in all patient categories except acute myelogenous leukemia and acute lymphoblastic leukemia (P = .001), (2) ≥5 × 10⁶/kg CD34 + cells infused predicted better transplantation outcome in all patient categories (P < .0001) except acute myelogenous leukemia and acute lymphoblastic leukemia, (3) 1 or 2 aphereses (P = .001) predicted good outcome, (4) toxicity increased with higher graft volume reinfused (>500 mL) (P = .002), and (5) patients with a central venous catheter during both collection and infusion of PBSC had a more favorable outcome post-PBSCT than peripheral access (P = .007). The type of mobilization regimen did not affect the outcome of auto-PBSCT. The present study identified predictive variables, which may be useful in future individual pretransplantation probability evaluations with the goal to improve supportive care.     

Tranexamic Acid and Intraoperative and Postoperative Accumulative Bleeding in Elective Degenerative Spine Surgery

PurposeSpinal surgeries are often associated with a high incidence of perioperative blood loss, which poses several complications. Much current research focuses on the importance of antifibrinolytic drugs during spinal surgeries to reduce blood loss, which can also reduce the risk of the need for blood transfusions. We evaluated the effects of prophylactic, low-dose tranexamic acid (TXA) in spinal fusion surgeries on blood loss, blood transfusions, and associated complications.Materials and MethodsTXA was administered to 90 patients at a constant infusion rate of 10 mg/kg for 20 minutes after anesthesia induction, followed by a maintenance dose of 1 mg/kg/h until the end of the operation. An additional 91 patients were included as controls.ResultsThere were no significant differences between the study groups in terms of intraoperative blood loss, which was 500 mL for both groups (p>0.999). Also, intraoperative blood transfusion requirements were similar between both groups (p=0.330). Mean blood transfusion amounts were 125±35 mL for patients in the TXA group and 85±25 mL in the control group. However, there was a significant reduction in postoperative blood transfusion (p=0.003) in the TXA group. Only three cases in the TXA group required blood transfusion, while 15 cases in the control group did.ConclusionWe confirmed that low dose TXA has no effect on intraoperative blood loss volume or blood transfusion requirements and that it can significantly reduce the need for postoperative blood transfusions.