自体血液稀释及术中出血回输方法在骨科手术中的应用

目的 介绍采用自体血液稀释法和术中出血回输法进行输血的初步经验。方法 1998年 9月～ 1999年 10月对 70例骨科择期手术患者采用自体输血技术,稀释法 24例,术中出血回输法 46例。观察患者术前、术中、术后的血流动力学、血液有形成分和凝血功能变化。结果 稀释组中 15例（ 62.5％）单纯采用自体血液稀释法完成手术,另 9例加输库存血,其用血量较以往同类手术明显减少。术中出血回输组的回收总血量为 49 669 ml,平均每例回收 1 080 ml,与对照组比较人均输库存血量减少 72.5％。 70例患者术中血流动力学稳定,均顺利完成手术,无不良反应。结论 采用血液稀释法和术中出血回输法进行自体输血与输库存血比较,差异无显著性意义 (P >0.05),故血液稀释法及术中出血回输法用于骨科手术是安全、可行的方法。     

自体血液稀释及术中出血回输方法在人工关节置换术中的应用

目的:介绍采用自体血液稀释法和术中出血回输法在人工关节置换术进行输血的初步经验。方法:对56例人工髋、膝关节置换术患者采用了自体输血技术,稀释法18例,术中出血回输法38例。观察患者术前、术中、术后的血流动力学、血液有形成分和凝血功能变化。结果:稀释组中12例(67％)单纯采用自体血液稀释法完成手术,另6例加输库存血,其用血量较以往同类手术明显减少。术中出血回输组的回收总血量39050ml,平均每例回收1028ml,与对照组比较人平均输库存血量减少69.9％。56例患者术中血流动力学稳定,均顺利完成手术,无不良反应。结论:采用血液稀释法和术中出血回输法进行自体输血与库存血比较,差异无显著意义(P>0.05),血液稀释法及术中出血回输法可根据情况单独或联合使用,在人工关节置换手术中是节约用血、安全、可靠的方法。     

稀释式自体输血在骨科手术中的应用

目的 探讨稀释式自体输血在骨科择期手术中的应用。方法 选择１９例骨科择期手术需要输血的患者，术前采集处体血液，同时输入等量的血浆代用品血定安（Ｇｅｌｏｆｕｓｉｎｅ）和５００ｍｌ乳酸林格液，采血４００￣６００ｍｌ，手术结束前回输。观察采血前后及术后患者血液动力学、血液有形成分，凝血功能等方面的变化。结果 １９例患者均安全，顺利完成手术，无不良反应。结论 稀释式自体输血可以满足骨科择期手术的需要。     

预贮式自体输血和急性等容性血液稀释联合应用于颅脑外科手术的临床研究

目的 探讨在颅脑外科手术中联合应用预贮式自体输血和急性等容性血液稀释的安全性和临床效果。方法 63例病人随机分为预贮式自体输血组(A组31例)和联合应用预贮式自体输血和急性等容性血液稀释组(B组32例)。两组在采血前、术前即刻放血前、放血后、回输自体血后、术后第1天分别测定Hb、Hct、Pt及PT、APTT、FIB，监测MAP、CVP、SpO2、HR，两组出血量、输异体血量。结果 A、B组Hb、Hct术中降低，与术前比较有显著性差异(P＜0．05)，回输自体血后回升。A、B两组PT、APTT术中延长，FIB和Pt未见明显改变。两组术中血流动力学稳定。A组采血量明显少于B组(P＜0．05)，输异体血量明显多于B组（P＜0．05)。结论 联合应用预贮式自体输血和急性等容性血液稀释有明显节血效应，对血液生理学影响小，血流动力学稳定。     

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。     

自体血小板分离联合术中自体血回输对骨科手术患者凝血功能的影响作用

目的观察术前自体血小板分离联合术中自体血回输对骨科手术患者凝血功能的影响作用。方法60例骨科择期手术患者（预计出血量〉1000ml,ASAⅠ～Ⅱ级）,随机分为3组,每组20例患者。Ⅰ组采用术前自体血小板分离联合术中自体血回输,Ⅱ组采用单纯术中自体血回输,Ⅲ组不进行任何血液保护措施。各组分别于麻醉前、血小板分离后10min、保存的血小板或自体血回输前10min、回输后10min、术后24h、术后48h检测相应时点的血红蛋白水平、凝血功能、血小板水平和聚集功能、术中术后出血量及异体输血情况。结果三组的一般资料、术中出血量、术中术后的血红蛋白水平比较未见明显差异。与Ⅰ组相比,Ⅱ、Ⅲ组术后24h和术后48h的血小板水平和聚集功能明显降低（P〈0．05）,术后出血量及异体输血率则明显增高（P〈0．01）。结论术前自体血小板分离联合术中自体血回输可明显改善骨科手术患者的凝血功能,并有效降低术后出血量和异体血的输注。     

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。     

术中自体血回输与输注异体血对脊柱手术术后血液流变学的影响

目的 对比术中自体血回输和输注异体血对脊柱手术病人血液流变学（凝血功能）的影响,进一步探讨术中血液回收的安全性和可行性。方法 选择2015年1月至2016年12月我院收治的术前实验室检验正常、无凝血功能异常且未接受抗凝治疗、非恶性肿瘤、术中血液无污染的骨科脊柱开放性手术病人100例。严格遵守献血与输血的伦理准则分组：①自体血液回输组（自体组）,即术中回输经洗涤处理的自体血,男22例,女28例;②异体输血组（异体组）,即行异体输血,男23例,女27例。两组病人一般资料比较,差异均无统计学意义（均P＞0.05）。同时进行血液流变学项目监测,并对比输血对病人凝血功能的影响。结果 自体组的术中回输自体血量为（289.4±55.7） ml,少于异体组的异体输血量［（396.5±141.1） ml］,两者比较差异有统计学意义（t=4.992,P＜0.05）。术后第3天两组病人的红细胞压积,自体组为31.00%±5.84%,小于异体组的34.25%±6.15%,两组比较差异具有统计学意义（t=2.710,P=0.007）;两组病人其余血液流变学参数比较,差异均无统计学意义（均P＞0.05）。术后第7、14天,两组病人各项血液流变学参数比较,差异均无统计学意义（均P＞0.05）。结论 自体血回输对血液流变学参数的影响与输注异体血相比无显著差异,可广泛应用于临床。     

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。     

急性等容血液稀释结合术中自体血回输在脊柱手术中的应用

目的 探讨急性等容血液稀释结合术中自体血回输在脊柱手术中临床应用的可行性。方法 38例腰椎滑脱行后路减压、椎弓根螺钉内固定加椎体间Cage融合术患者,随机分为三组,急性等容血液稀释结合术中自体血回输组(组Ⅰ,n=12);自体血回输组(组Ⅱ,n=12);对照组(组Ⅲ,n=14)。术中均采用控制性低血压,记录术前、术中、回输前、回输后、术后的血红蛋白和红细胞比容,分别记录回输的血量和输异体血量。结果 急性等容血液稀释结合术中自体血回输组术中输异体血量约100ml,自体血回输组输异体血量约400ml,对照组输异体血量约800ml,经统计学检验有显著差异(P<0.05)。结论急性等容血液稀释结合术中自体血回输在脊柱手术中临床应用是一种安全有效、节约血源的方法,可减少异体血输入,避免其并发症。     

Preoperative hemodilution to reduce homologous blood transfusion--effects on hemodynamics and oxygen flux]

Many problems arise from homologous blood transfusion in operative patients. Preoperative collection of blood with hemodilution is a simple method to allow autologous blood transfusion. Sixty patients who received gynecological operations were divided into three groups. Patients in the first and second groups underwent preoperative blood collection and hemodilution, and collected blood was transfused during operation when bleeding volume had exceeded prefixed value. The volume and speed of blood collection were 20 ml.kg-1 and 30 minutes in the first group, and 20 ml.kg-1 and 15 minutes in the second group. After the collection of blood, HES solution was infused to maintain blood volume. The patients in the third group were transfused with homologous blood as controls. The blood pressure, heart rate, cardiac index and oxygen flux were maintained well in the first group after collection of blood and hemodilution. The hemoglobin concentration was kept at 10 g.dl-1 when the operation was terminated with a mean bleeding volume of 1,014 ml. The results suggest that the method of preoperative blood collection and hemodilution followed by autologous blood transfusion is a promising technic to reduce the amount of homologous blood transfusion in operative patients.     

Effectiveness of postoperative autologous blood transfusion after knee replacement surgery and influence of preoperative hemoglobin level

OBJECTIVE: To evaluate the effectiveness of postoperative autologous blood transfusion on reducing the need for allogenic transfusion during recovery from total knee arthroplasty until hospital discharge, and to determine whether effectiveness is related to preoperative hemoglobin level. MATERIAL AND METHODS: Retrospective study of patients undergoing surgery at Hospital Jerez de la Frontera, Spain, in 2003, assessing the association between postoperative autologous blood transfusion, preoperative hemoglobin, and allogenic transfusion requirements. RESULTS: A total of 107 patients were studied. Eighty-three received autologous blood transfusions after surgery and 15 (14.02%) required allogenic transfusion. The rate of allogenic transfusion was higher in association with hemoglobin levels exceeding 13 g x dL(-1) (P=0.003) and it was lower in patients who received autologous blood transfusions (P=0.046). In patients who received autologous transfusion, preoperative hemoglobin level and risk of allogenic transfusion were unrelated. When autologous transfusion was not given, allogenic transfusion risk was higher when hemoglobin concentration was less than 13 g x dL(-1) (P=0.0008). Autologous transfusion had a significant effect when hemoglobin level was less than 13 g x dL(-1) (P=0.002) but did not affect the rate of transfusion when hemoglobin was 13 g x dL(-1) or more. CONCLUSIONS: Autologous blood transfusion is effective for reducing the need for allogenic transfusion after knee replacement surgery, particulary when a patient's hemoglobin level is less than 13 g x dL(-1).     

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。     

自体输血在人工关节置换术的应用

目的人工髓、膝关节置换术后出血量较大,尤其是膝关节置换术后平均引流量达６００～８００ｍｌ,常需输血治疗。而异体输血可引起许多不良反应和并发症,因此自体输血技术日益受到重视。本文介绍自体输血的初步经验。方法自１９９１年起,我院骨关节科共对４３３例施行人工髋、膝关节置换术的患者采用了自体输血技术,主要方法包括术前预存自体血和术后引流血回输技术。结果单纯依靠术前预存自体血输血组,术后约有６９％（２５８／３７４）的患者无需异体输血而顺利渡过围手术期,其中９３．４％（２４１／２５８）为单侧关节置换患者,６．６％（１７／２５８）为双膝、双髋或单侧膝髋同时置换的患者;而在单纯术后引流血回输组和两种方法结合组,这一比例则分别为３６％（５／１４）和７５．６％（３４／４５）。结论采用术前预存自体血加术后引流血回输的方法,可使多数施行人工髋、膝关节置换术的病例避免了异体输血及由此带来的潜在危险。     

Autologous blood donation in total knee arthroplasties is not necessary

BACKGROUND: This study intends to prove the hypothesis that preoperative autologous blood donation in total knee arthroplasties (TKA) is dispensable. PATIENTS AND METHODS: The study comprises a prospective analysis of 81 consecutive TKA without preoperative autologous blood donation (AB-donation). Guidelines for blood retransfusion were used. Surgery, as well as the pre- and postoperative procedures were identical for each patient. In the analysis of the data, the consecutive TKAs were divided into patients who were eligible for preoperative autologous blood donation (group 1, n = 46) and those with relevant risk factors not permitting preoperative autologous blood donation (group 2, n = 35). RESULTS: None of the patients in group 1 needed a blood transfusion. 14 of 35 patients in group 2 needed an allogenic blood transfusion. INTERPRETATION: Total knee arthroplasty can be managed without preoperative AB-donation if it is performed using a tourniquet, if a postoperative collection and direct retransfusion system is used for the wound blood, and if the transfusion algorithm is defined according to compulsory and practical guidelines.     

Acute normovolemic hemodilution for radical prostatectomy: Can it replace preoperative autologous blood transfusion?

BACKGROUND: Although preoperative autologous blood donation (PAD) is accepted as a standard of care for radical prostatectomy, it is costly, time-consuming and has risks associated with blood storage. Acute normovolemic hemodilution (ANH) is reported to be less expensive and to preserve blood components more effectively than PAD. In the present study, the efficacy and safety of these two autologous blood-collection techniques were compared. METHODS: The study included 16 consecutive patients scheduled for radical prostatectomy. The first eight patients underwent conventional preoperative autologous blood donation of 400 mL 1 week before the operation (PAD group) and the second eight patients underwent acute normovolemic hemodilution followed by immediate operation (ANH group). All blood collected was transfused in the perioperative period. Preoperative and postoperative hematocrit levels in these two groups were compared. RESULTS: There were no differences in preoperative hematocrit, time of operation or operative blood loss between the two groups. In the ANH group, 1080 +/- 160 mL of blood were collected. The postoperative hematocrit level did not differ significantly between the groups. No patient in either group received allogeneic blood transfusion or experienced an adverse event directly related to blood transfusion. CONCLUSION: The two blood-conservation strategies resulted in similar postoperative hematologic outcomes. Given its advantages, which include lower cost, lower risk and higher convenience, ANH is one of the procedures that may replace conventional PAD for use in radical prostatectomy.     

Combination of acute normovolemic hemodilution technique with preoperative autologous blood donation prevented allogeneic blood transfusion against 4000 g surgical blood loss in a patient undergoing left partial nephrectomy

A 41-year-old male patient with well-controlled hypertension underwent a partial nephrectomy under total intravenous anesthesia with propofol, fentanyl and ketamine. To avoid allogeneic blood transfusion, preoperative autologous blood donation (400 g) a week before the surgery and acute normovolemic hemodilution (800 g) after induction of anesthesia were performed. As surgical blood loss was more than 4000 g, blood hemoglobin (Hb) level decreased to 6.4 g.dl-1. However, as intraoperative hemodynamics was relatively stable with no ischemic changes in ECG and arterial blood gas analysis did not show metabolic acidosis, autologous blood transfusion was withheld till hemostasis had been done. After returning the autologous blood, Hb increased to 9.4 g.dl-1. On the 2nd postoperative day, Hb decreased to 7.6 g.dl-1. As the patient's vital signs did not show any severe complications, blood transfusion was not performed. Then, the Hb level increased gradually to 13.9 g.dl-1, 3 month later without allogenic blood transfusion. In addition, any postoperative complications by low Hb level were not recognized so far. This case suggests that combination of autologous transfusion techniques may be effective to avoid allogeneic blood transfusion even against massive hemorrhage. However, to avoid disadvantage of these technique, we should always evaluate preoperative patient conditions.     

Erythropoietin alone or as an adjuvant for the autologous blood donation program in major orthopedic surgery

BACKGROUND: Patients with anemia undergoing elective joint replacement are often excluded from preoperative autologous donation (PAD). The purpose of this study was to compare the efficacy of preoperative erythropoietin (epoetin alpha) as an adjuvant treatment to PAD versus preoperative erythropoietin alfa alone in patients with mild anemia undergoing major orthopedic surgery. PATIENTS AND METHODS: The study enrolled 75 patients scheduled for total joint arthropalsty of the hip or knee or spinal surgery and with a hemoglobin (Hb) concentration between 10 and 13 g/dL. Group 1 patients were assigned to receive weekly doses of subcutaneous epoetin alpha (40,000 IU) 21, 14, and 7 days before surgery and to participate in the PAD program; group 2 patients were excluded from the PAD program and received 2 doses of epoetin alpha every week over the same period. RESULTS: Group 1 (n = 39) and group 2 (n = 36) were similar with respect to patient characteristics, biological parameters, and surgical procedures, In group 1, mean preoperative Hb rose fom 12.5 g/dL to 12.8 g/dL, patients received a mean 5.1 doses of epoetin alpha, and they gave a mean 1.9 units of autologus blood and 1 received allogenic blood. In group 30.7% received transfusions of autologous blood and 1 received allogenic blood. In group 2, preoperative Hb increased from 11.7 g/dL to 13.5 g/dL, patients received 3.8 doses of epoetin alpha, and 3 were transfused with allogenic blood (P > 0.05). CONCLUSION: Epoetin alpha alone and erythropoietin as a adjuvant to a PAD program are equally effective in reducing allogenic transfusion during hip and knee arthroplasty and spinal column surgery of up to 3 spaces.     

Intraoperative autologous blood salvage with cardiac surgery: an analysis of five years' experience in more than 3,000 patients.

STUDY OBJECTIVE: To analyze intraoperative autologous salvage of shed mediastinal blood and subsequent transfusion in cardiac surgery. DESIGN: Retrospective statistical analysis. SETTING: University hospital. PATIENTS: Three thousand twenty two patients undergoing cardiac surgery from 1984 to 1988. INTERVENTIONS: A review of anesthesia and transfusion records of all patients who underwent intraoperative salvage of shed blood and autologous transfusion using the Sorenson Receptal Auto Transfusion System (ATS) with saline wash prior to reinfusion in cardiac surgery. MEASUREMENTS AND MAIN RESULTS: The salvaged blood volume ranged from 36 to 2,795 ml, with a mean of 321 +/- 222 ml (SD). Eighteen percent of patients did not receive any homologous blood products during their hospitalization. Patients who received only salvaged autologous transfusion were younger, had higher preoperative hemoglobin and hematocrit values, had a larger body surface area, and had shorter surgeries compared with patients who received only homologous blood or both autologous and homologous blood. More blood products were given to patients who received salvaged autologous blood compared with those who did not. Patients who underwent normovolemic hemodilution prior to extracorporeal circulation with subsequent reinfusion received significantly fewer blood products. Ten preoperative and four intraoperative variables significantly influenced the salvaged volume. Previous cardiac surgery was the most significant preoperative variable, and repair of ventricular septal defect produced by myocardial ischemia was the most significant intraoperative variable. CONCLUSION: Considering the average salvaged volume and its current autologous transfusion-related expense, autologous blood salvage is potentially an economic benefit. Perioperative blood conservation requires a considerable commitment from surgeons, anesthesiologists, perfusionists, and intensive care physicians to be effective.     

Comparison of autologous transfusion drains versus no drain in total knee arthroplasty

Primary total knee arthroplasty is associated with blood loss both during surgery and in the immediate postoperative period, that may require allogenic blood transfusion. In view of the risks and financial implications of using allogenic blood, an accepted solution has been to utilise autotransfusion drains in the postoperative period thus allowing re-infusion of a patient's own blood. A number of studies have compared retransfusion techniques with standard drain use, but few report comparison with no drain use at all. We analysed data from patients undergoing primary total knee arthroplasty within our unit over an 18-month period. A total of 121 patients were included in the study: 53 received retransfusion drains whilst the remaining 68 received no drain at all. The mean postoperative haemoglobin drop was not significantly different between the two groups (p > 0.05). In the retransfusion group only one patient (2%) required allogenic blood transfusion postoperatively, whilst 4 of the 68 (6%) did so in the control group. This difference was not statistically significant either. This study showed a low rate of allogenic blood use postoperatively (< 5%) where either a retransfusion drain or no drain was used at all. However because there was no measurable difference between the two, we conclude that using a retransfusion technique does not appear to be of significant financial or clinical benefit with regards to allogenic blood transfusions compared with using no drain.