围手术期临床用血调查分析推测改进输血治疗指征的必要性

目的  调查分析手围术期临床输血量和输血率的变化趋势及输血存在的问题,探寻改进围手术期新的输血治疗指征的必要性。方法  评估遵义医学院附属医院临床围手术期接受输血的1 000例患者,分别对围手术期血液制品使用情况及手术前后红细胞压积比（Hct)、红细胞计数（RBC）、血红蛋白（Hb）检查结果进行回顾性分析;观察2006～2009年各种血液制品的使用情况,比较输血前后Hb和RBC的变化,探寻新的输血治疗指征。结果  围手术期全血使用率逐渐下降（6.50%）,2006～2009年红细胞使用率为74.60%,血浆使用率为23.30%,血小板为0.04%,自体血使用率为44.70%;全血人均使用量逐渐减少,成分血人均用量逐渐增多,各成分血使用中以红细胞为主;术前Hb平均10 g/dl左右,输血前Hb、RBC及Hct略高于输血后,且输血人群Hb> 7 g/dl的患者占大多数。结论  血液制品使用逐渐合理,输血指征掌握不好,用血问题尚存;输血治疗指征迫切需要改进,其对HB 7～10 g/dl的患者更具有临床意义。

     

危重地震伤员术中容量治疗

目的分析2008年5月12日-2008年6月11日行手术治疗的汶川地震危重伤员（ASA3～5）的围术期容量治疗,总结经验与教训,为以后可能实施的大规模伤员手术救活中容量治疗提供参考。方法收集整理所有危重地震伤员术中输液、输血记录及血液学检查指标,观察术前术后血红蛋白（Hb）、血细胞比容（Hct）和血小板计数（Plt）的变化。结果我院共对危重伤员行手术治疗244台次,术中输注晶体液、胶体液、血液制品行容量治疗,其中输血治疗167台次,共计用血液制品118500ml,其中RBC80200ml（67．68％）,FFP38300ml（32．32％）。术后有55例次（32．8％）的伤员的Hb、Hot、Ph均较术前下降,Hb从78～142g／L降至56～108g/L,Het从25％～38％降至15％～25％、Pit从（186—256）×10^9／L降至（73—129）×10^9／L;有61.1％（102例）伤员术后Hb、Hct、Plt上升,Hb从47～97g/L升至88—145g／L,Hot从18％-29％升至26％-41％,Pit从（66～123）×10^9／L升至（118—263）×10^9／L;术中、术后未发生严重输血相关性不良反应。结论在地震伤员的救治中,常使用晶体液、胶体液补充有效循环血容量后,再根据可靠的血液指标,输注血液制品（RBC、FFP以2：1的比例输注,按需输注血小板）。     

Autologous versus allogeneic transfusion: patients'' perceptions and experiences

BACKGROUND: Preoperative autologous donation is one way to decrease a patient's exposure to allogeneic blood transfusion. This study was designed to determine patients' perceptions about the autologous blood donation process and their experiences with transfusion. METHODS: To assess patient perception, a questionnaire was administered a few days before surgery to patients undergoing elective cardiac and orthopedic surgery in a Canadian teaching hospital. All patients attending the preoperative autologous donation clinic during a 10-month period were eligible. A convenience sample of patients undergoing the same types of surgery who had not predonated blood were selected from preadmission clinics. Patient charts were reviewed retrospectively to assess actual transfusion practice in all cases. RESULTS: A total of 80 patients underwent cardiac surgery (40 autologous donors, 40 nondonors) and 73 underwent orthopedic surgery (38 autologous donors, 35 nondonors). Of the autologous donors, 75 (96%) attended all scheduled donation appointments, 73 (93%) said that they were "very likely" or "likely" to predonate again, and 75 (96%) said that they would recommend autologous donation to others. There was little difference in preoperative symptoms between the autologous donors and the nondonors, although the former were more likely than the latter to report that their overall health had remained the same during the month before surgery (30 [75%] v. 21 [52%] for the cardiac surgery patients and 30 [79%] v. 18 [51%] for the orthopedic surgery patients). When the autologous donors were asked what they felt their chances would have been of receiving at least one allogeneic blood transfusion had they not predonated, the median response was 80%. When they were asked what their chances were after predonating their own blood, the median response was 0%. The autologous donors were significantly less likely to receive allogeneic blood transfusions (6 [15%] for cardiac surgery and 3 [8%] for orthopedic surgery) than were the nondonors (14 [35%] for cardiac surgery and 16 [46%] for orthopaedic surgery). They were, however, more likely to receive any transfusion (autologous or allogeneic) than were the nondonors (25 [63%] v. 14 [35%] for cardiac surgery and 31 [81%] v. 16 [46%] for orthopedic surgery). INTERPRETATION: Patients who underwent preoperative autologous blood donation were positive about the experience and did not report more symptoms than patients who did not donate blood preoperatively. Autologous donors overestimated their chances of receiving allogeneic blood transfusions had they not predonated and underestimated their chances after they had predonated. They were less likely to receive allogeneic transfusions, but more likely to receive any type of transfusion, than were patients who did not predonate.     

红细胞保存时间对红细胞输注前后Hb变化的影响

目的 研究不同保存时间红细胞对输注前后血红蛋白(Hb)变化的影响.方法 选取中国人民解放军总医院海南分院2012年3月5日至2015年11月4日期间全部有红细胞输注记录,且符合入选标准的997袋血液,分析保存时间同输血前后Hb变化关系.结果 红细胞保存期从1~5周的输血前后变化依次为(14±8)g/L、(14±9)g/L、(14±10)g/L、(14±10)g/L、(14±9)g/L,不同保存时间红细胞输血前后Hb变化差异均无统计学意义(R2=-0.0001,P>0.05).结论 对于短期内以提高Hb为目的的红细胞输注,保存时间对输血效果的影响较小.     

预贮式自体输血在法乐氏四联症手术中的应用

目的 :比较预贮式自体输血 (PredepositAutotransfu sion ,PAT)和异体输血 (homologousbloodtransfusion ,HBT)在先天性心脏病法乐氏四联症心脏直视手术中的应用效果 .方法 :严格筛选 2 4例患者 ,分为两组 ,其中PAT1 0例 ,HBT1 4例 .比较两组间术后 1 2h内的血红蛋白 (Hb)、红细胞压积(HCT)、中心静脉压 (CVP)、输血量及术后胸腔引流量的差异 .结果 :两组对比 ,术前RBC ,Hb,HCT ,WBC ,PLT无统计学显著性差异 (P >0 .0 5 ) ,术后 1 2h内Hb ,HCT ,CVP ,输血量及胸腔引流量无统计学显著性差异 (P >0 .0 5 ) .结论 :在先天性心脏病法乐氏四联症体外循环心脏直视术患者中 ,PAT与HBT在血液学和血液动力学方面效果相同     

分析RhE抗原分布检测对临床输血的价值

分析恒河猴E抗原(RhE)分布检测对临床输血的价值,为临床实践提供参考。对本院临床住院及献血人员恒河猴D抗原(RhD)血液样本16 800例进行RhE、e表型鉴定分析,并分析其中2 280例RhE阴性接收RhE阳性血液后不规则抗体的变化,分析患者输血前后血液指标的变化情况。结果显示16 800例RhD血液样本Dee、DEe及DEE表型分别为8 420(50.1%)、6 847(40.8%)和1 533(9.1%);RhE阴性患者接收RhE阳性血液后不规则抗体分析发现产生阳性抗体共有185例,占8.1%,且两组患者输血前后胆红素及网织红细胞无明显变化,而3次及以上输血患者输血后血红蛋白(Hb)及红细胞(RBC)明显升高(P<0.05)。因此,RhE抗原分布检测指导临床同型输血具有重要的价值。     

多发伤患者红细胞输注后的效果评价

目的评价多发伤患者输注红细胞后的临床效果。方法115例多发伤输注红细胞患学按照性别分为两组,研究两组的输血反应、ALT、TP、CR、K＋、BUN以及Hb在治疗前后的差异。结果71％的患者输注后血压等指标恢复良好。输血前和输血后48h相比：男性和女性的TP、CR、BUN以及Hb之间的差异具有统计学意义;男性输血前后K＋差异无统计学意义,女性输血前后K＋差异具有统计学意义;而ALT的差异无统计学意义。结论多发伤患者进行红细胞输注,有效地改善了患者的循环,且对血钾和ALT的改变不大,起到了良好的治疗效果。     

预储式自体输血在泌尿外科择期手术中的应用

目的探讨在泌尿外科择期手术中应用预储式自体输血的疗效。方法回顾性分析应用预储式自体输血的20例患者的情况。结果 20例患者在采血后、手术后血常规指标比采血前、手术前均有下降,但PLT、Hct、Hb均维持在较高水平（PLT〉150×109/L、Hct〉30%、Hb〉110g/L）,因此,不会造成凝血功能障碍和组织缺氧。结论预储式自体输血是一种有效、安全的输血方式,可解决择期手术的输血要求,输血的不良反应可有效减少,输血的安全性可提高,具有深远的经济意义和社会意义。     

Randomized Controlled Study on Safety and Feasibility of Transfusion Trigger Score of Emergency Operations

Background:

Due to the floating of the guideline, there is no evidence-based evaluation index on when to start the blood transfusion for patients with hemoglobin (Hb) level between 7 and 10 g/dl. As a result, the trigger point of blood transfusion may be different in the emergency use of the existing transfusion guidelines. The present study was designed to evaluate whether the scheme can be safely and effectively used for emergency patients, so as to be supported by multicenter and large sample data in the future.

Methods:

From June 2013 to June 2014, patients were randomly divided into the experimental group (Peri-operative Transfusion Trigger Score of Emergency [POTTS-E] group) and the control group (control group). The between-group differences in the patients’ demography and baseline information, mortality and blood transfusion-related complications, heart rate, resting arterial pressure, body temperature, and Hb values were compared. The consistency of red blood cell (RBC) transfusion standards of the two groups of patients with the current blood transfusion guideline, namely the compliance of the guidelines, utilization rate, and per-capita consumption of autologous RBC were analyzed.

Results:

During the study period, a total of 72 patients were recorded, and 65 of them met the inclusion criteria, which included 33 males and 32 females with a mean age of (34.8 ± 14.6) years. 50 underwent abdomen surgery, 4 underwent chest surgery, 11 underwent arms and legs surgery. There was no statistical difference between the two groups for demography and baseline information. There was also no statistical differences between the two groups in anesthesia time, intraoperative rehydration, staying time in postanesthetic care unit, emergency hospitalization, postoperative 72 h Acute Physiologic Assessment and Chronic Health Evaluation II scores, blood transfusion-related complications and mortality. Only the POTTS-E group on the 1^st postoperative day Hb was lower than group control, P < 0.05. POTTS-E group was totally (100%) conformed to the requirements of the transfusion guideline to RBC infusion, which was higher than that of the control group (81.25%), P < 0.01. There were no statistical differences in utilization rates of autologous blood of the two groups; the utilization rates of allogeneic RBC, total allogeneic RBC and total RBC were 48.48%, 51.5%, and 75.7% in POTTS-E group, which were lower than those of the control group (84.3%, 84.3%, and 96.8%) P < 0.05 or P < 0.01. Per capita consumption of intraoperative allogeneic RBC, total allogeneic RBC and total RBC were 0 (0, 3.0), 2.0 (0, 4.0), and 3.1 (0.81, 6.0) in POTTS-E groups were all lower than those of control group (4.0 [2.0, 4.0], 4.0 [2.0, 6.0] and 5.8 [2.7, 8.2]), P < 0.05 or P < 0.001.

Conclusions:

Peri-operative Transfusion Trigger Score-E evaluation scheme is used to guide the application of RBC. There are no differences in the recent prognosis of patients with the traditional transfusion guidelines. This scheme is safe; Compared with doctor experience-based subjective assessment, the scoring scheme was closer to patient physiological needs for transfusion and more reasonable; Utilization rate and the per capita consumption of RBC are obviously declined, which has clinical significance and is feasible. Based on the abovementioned three points, POTTS-E scores scheme is safe, reasonable, and practicable and has the value for carrying out multicenter and large sample clinical researches.     

Hemoglobin H disease--ten years' experience

Eighty-eight patients with Hemoglobin (Hb) H diagnosed in our hospital in the past decade were reviewed. Among them, 37 were males and 51 were females, and their age ranged from 10 to 77 years. In physical examination, 43.3% of them showed to have jaundice, 47% had splenomegaly, 14% had hepatomegaly and 19.3% had gall stone. Hb electrophoresis revealed the presence of Hb H (1.4-40%), Hb F (23/88, range: 0.5-7.5%) and decreased Hb A2 (mean = 1.23 +/- 1.2%). The study of iron status showed increased serum ferritin concentration (mean = 421.4 +/- 343.7 ug/dl) and transferrin saturation ratio (53.9% +/- 20.5%). Hemosiderosis was found in three out of four patients received liver biopsy. Although most patients did not receive blood transfusion frequently, iron overload was not uncommon in the patients with Hb H disease. Further study would be needed to explore the true relationship between iron overload and Hb H disease.     

预存联合术中回收式自体输血对择期手术患者的临床研究

目的 探讨预存联合术中回收式自体输血对择期手术患者的临床效果。 方法 采用随机数字法将84例择期手术患者随机分为2组,每组42例。对照组给予异体输血,观察组给予预存联合术中回收式自体输血。治疗前后,检测患者血液相关指标(Hb、Hct、PLT、PT、APTT)、炎症介质(TNF-α、补体C3)、外周血T淋巴细胞亚群(CD4、CD4/CD8、CD8)和NK细胞、免疫球蛋白(IgA、IgG、IgM)水平,并统计不良反应发生情况。 结果 治疗后,观察组Hb、HCT、PLT、PT、APTT水平与治疗前比较差异无统计学意义(P>0.05);对照组Hb、HCT、PLT、PT、APTT水平则明显下降(P<0.05);且观察组Hb、HCT、PLT、PT、APTT水平显著高于对照组(P<0.05)。治疗后,观察组补体C3、CD4、CD4/CD8、NK细胞、IgA、IgG、IgM水平与治疗前比较显著升高(P<0.05);对照组补体C3、CD4、CD4/CD8、NK细胞、IgA、IgG、IgM水平则明显下降(P<0.05);而且观察组补体C3、CD4、CD4/CD8、NK细胞、IgA、IgG、IgM水平明显高于对照组(P<0.05)。治疗后,观察组TNF-α显著降低,而对照组TNF-α显著升高,且观察组TNF-α显著低于对照组 (P<0.05)。观察组不良反率为0.0%,显著低于对照组的14.3%(P<0.05)。 结论 相比于异体输血,预存联合术中回收式自体输血可有效调节患者炎症和免疫功能,利于预后恢复。      

围手术期应用重组人红细胞生成素的多中心随机对照研究

目的 观察围手术期贫血患者使用重组人红细胞生成素（rhEPO）对纠正贫血和减少异体输血的临床效果.方法 74例胃肠道肿瘤伴贫血患者,随机分成治疗组A、治疗组B和对照组C,A组患者术前每天皮下注射rhEPO 1万IU,连续4 d,术后第1、3 d分别皮下注射rhEPO 1万IU;B组患者术前7 d始隔天皮下注射rhEPO 1万IU,连续6次;C组患者不给予rhEPO.观察所有患者贫血纠正及异体输血情况.结果 治疗组患者用药后血红蛋白（Hb）、网织红细胞（Ret）及血细胞比容（Hct）水平高于对照组、用药前,术中及术后异体输血少于对照组.B组疗效优于A组.结论 围手术期使用rhEPO对于纠正贫血和减少异体输血是有效的.     

Hematopoietic stem cell transplantation for beta-thalassemia major]

OBJECTIVE: To discuss the feasibility of hematopoietic stem cell transplantation for beta-thalassemia major. METHODS: Bone marrow or cord blood of sibling was transplanted to 4 children with thalassemia, whose type of gene mutations was homozygous. All of them were diagnosed as beta-thalassemia major. HLA type was matched in 2 cases, and mismatched with 1 locus in the other 2. RBC type was mismatched in 1 cases. Pretransplant condition including busulfan (BU) 16 mg/kg, cyclophosphamide (CY) 200 mg/kg and anti-thymocyte globulin (ATG) 90 mg/kg. Graft-versus-host disease (GVHD) prophylaxis was cyclosporine-A (Cs-A) and methotrexate (MTX). RESULTS: Two Children had "serum sickness" during pretransplant condition; two children had grade II acute GVHD and 1 developed chronic GVHD, 1 case veno-occlusive disease (VOD), 1 case cytomegalovirus (CMV) interstitial pneumonia and 1 case fungemia post-transplant, which had been cured. The average time for peripheral WBC recovery > 1.0 x 10(9)/L was 16 days, 18 days for neutrophile granulocyte > 0.5 x 10(9)/L, 59 days for Plt > 50 x 10(9)/L and 39 days for Hb > 100 g/L. The average time for WBC recovery to normal was at day 24. The average time of last blood transfusion for patients was 29 days. The patients had to receive about 100 ml blood infusion per 2 months pretransplant, while not infused for 7 approximately 15 months up to now with Hb > 100 g/L. Gene mutation type of patients had changed to donor's. CONCLUSION: We report a successful transplantation of bone marrow and cord blood stem cells for thalassemia major in China. This will give a new strategy for treatment of the disease and further expand the use of stem cells transplantation.     

HemoCue Hb 201+分析仪在手术中的应用

目的 探讨与血气分析仪相比HemoCue Hb 201+分析仪的精确度,并且与麻醉医生凭经验判定输血时机相比使用HemoCue Hb 201+分析仪能否节约术中输血量.方法 随机选取胃癌全麻患者100例,ASA分级Ⅰ～Ⅱ级,年龄46～65岁,体重65～81 kg.选取手术任意时间点,对100例患者同时采用血气分析仪和H...     

琥珀酰明胶预扩容下结合监测Hb/Hct指导术中用血的效果

目的：评估琥珀酰明胶预扩容下结合监测Hb/Hct在手术麻醉中指导用血的效果。方法：手术病人100例,ASAⅠ-Ⅲ级,随机分A、B两组,每组病人50例,两组病人麻醉前琥珀酰明胶10mL.kg-1.h-1预扩容。A组麻醉前测Hb/Hct、术中输血前测、输血后30min测Hb/Hct,根据Hb/Hct确定是否输浓缩红细胞（PRBC）及PRBC量,术后复查Hb/Hct。B组术中根据经验判断是否输PRBC及输入量,同时测定输血前、输血后30min Hb/Hct作比较分析,术后复查Hb/Hct。结果：A组与B组麻醉诱导期间血流动力学稳定,A组用PRBC的病例数比B组少（P〈0.05）,A组用PRBC量比B组少（P〈0.05）,两组病人输PRBC后Hb/Hct对比无差异。结论：琥珀酰明胶预扩容下结合监测Hb/Hct在手术麻醉中能很好地指导用血,可以节约术中的用血。     

围手术期限制性红细胞输注的研究进展与指南对比

围手术期限制性输血策略认为异体红细胞输注的阈值可放宽至外周血血红蛋白浓度(Hb)<7~8 g/dl。限制性输血不仅有助于节约库存血,也可减少感染、免疫、容量负荷等方面的输血不良反应。从病生理角度,由于机体存在增加心输出量、调节血红蛋白与氧的结合率、扩张肺血管等代偿机制,故一定范围内Hb的下降未必导致缺氧。在接受髋关节手术、感染性休克和上消化道出血的患者中,限制性输血可使其获益;而在合并冠心病或接受心脏手术患者中,限制性输血可能与不良预后相关。多个学会发布的指南从不同角度推荐了限制性红细胞输注的适用范围,其中多将Hb<7 g/dl作为异体红细胞输注的指征之一,对Hb 7~10 g/dl者需依据预期出血量、患者代偿能力和代谢率具体分析。     

围手术期输血与先天性巨结肠根治术后感染关系的探讨

目的 了解围手术期输血对先天性巨结肠根治术后感染的影响。方法 从１９９５年１月至１９９７年４月,对８７例择期行先天性巨结肠根治术患儿进行前瞻性研究,输血组６１例,未输血组２６例。结果 ６１例输血组患儿中,２０例发生术后感染,感染率３２．８％。感染种类包括：腹腔脓肿２例,切口化脓１３例,支气管周围炎５例,肺炎３例,其中３例病人患两种感染;而未输血组２６例患儿中仅１例腹腔脓肿,输血及输血量与术后感染关     

不同输血方案在极重度自身免疫性溶血性贫血患者中的应用效果比较

目的:比较不同输血方案在极重度自身免疫性溶血性贫血患者中的应用效果。方法:回顾性分析2020年3月至2021年2月莆田市第一医院收治的96例极重度自身免疫性溶血性贫血(AIHA)患者的临床资料。根据输血方案不同分为甲组(n=30)、乙组(n=32)和丙组(n=34)。甲组采用去白细胞悬浮红细胞输血,乙组采用洗涤红细胞输血,丙组采用洗涤红细胞输血联合血浆置换。比较三组治疗前后实验室指标[血红蛋白(Hb)、红细胞计数(RBC)、网织红细胞(Ret)和总胆红素(TBiL)]水平、临床疗效、不良事件发生率及住院时间。结果:治疗后,丙组Hb、RBC水平均明显高于甲、乙组,Ret和TBiL水平均低于甲、乙组,差异有统计学意义(P<0.05);甲、乙两组Hb、Ret、RBC和TBiL水平比较,差异均无统计学意义(P>0.05);丙组治疗总有效率为97.06%(33/34),分别高于甲组的76.67%(23/30)和乙组的78.12%(25/32),差异均有统计学意义(P<0.05);三组输血不良事件发生率比较,差异无统计学意义(P>0.05);丙组住院时间分别短于甲、乙组,差...     

术中每搏变异度与控制性降压对行脊柱侧弯矫形术患者肾功能和出血量的影响和比较

目的：观察每博变异度对脊柱侧弯病人行侧弯矫正手术出血量和肾功能的影响。方法：SVV组维持SVV在8-12,CH组在进行椎体操作过程中平均动脉压（MAP）控制在50-60 mmHg。观察两组病人术中总失血量、输血率和输血量,比较术前、术毕肾功能变化。结果：SVV组和CH组术中出血量分别为（611±146）ml和（423±108）ml（P〈0.05）。术中CH组输血量明显少于SVV组,且2组比较输血率有显著性差异（P〈0.01）。两组病人术毕Hb和HCT均较术前降低,但SVV组下降更为明显（P〈0.01）。术前及术毕肾功能无明显变化。结论：以SVV 8-12为目标指导容量治疗虽可以维持血流动力学的平稳和有效的组织灌注,但输液量和出血量明显增多,CH可以更好的减少围术期输血、输液量,减少出血量;与SVV相比较更为经济适用。     

Red cell autoantibodies among thalassaemia patients in Hospital Universiti Sains Malaysia

INTRODUCTION: Thalassaemia is one of the major public health problems in Malaysia. Regular monthly blood transfusion remains the main treatment for severe thalassaemia patients. One of the complications of blood transfusion is the formation by the recipients of alloantibodies and autoantibodies against red blood cell (RBC) antigen. The purpose of this study was to determine the prevalence of RBC autoantibodies among multiple-transfused thalassaemic patients in our institution and factors that contribute to its development. METHODS: A prospective study was conducted in Haematology Laboratory, Hospital Universiti Sains Malaysia between January 2004 and December 2004. A total of 63 thalassaemia patients, who received regular blood transfusion were included in this study. Clinical and serological data were collected and analysed prospectively. Blood samples were subjected to standard blood bank procedures for screening of antibodies and their subsequent identification using reagent of Diamed-ID Gel microtyping system. RESULTS: There were 49 (77.8 percent) patients with Hb E/beta-thalassaemia, ten (15.9 percent) beta-thalassaemia major, three (4.7 percent) Hb H Constant Spring and one (1.6 percent) Hb H disease. Only one (1.6 percent) patient had autoantibodies. There were no statistical associations found between the formation of autoantibodies with age at the start of transfusion, number of packed cell transfused and splenectomy. CONCLUSION: Our data showed a low autoimmunisation rate in multiple-transfused thalassaemia patients in our hospital.