急性等容血液稀释用于子宫颈癌根治术的研究

目的：了解急性等容量血液稀释在子宫颈癌根治术中对输异体血量的影响。方法：择期子宫颈癌根治术患者16例．采用随机双盲方法分成两组，每组8例，Ⅰ组为对照组，Ⅱ组为血液稀释组，两组患者均采用两点连续硬膜外阻滞。Ⅱ组患者术前进行等容量血液稀释，比较两组患者术中所输异体血量和术后血红蛋白的变化。结果：Ⅱ组患者有6例完全避免输异体血，余下2例患者各输异体血400mL，Ⅰ组每例患者均需要输异体血．输血量为400-800mL，显著多于Ⅱ组，两组患者术后血红蛋白、红细胞压积均比术前有所下降，但两组患者同期相比差异无统计学意义，均在安全范围。结论：急性等容量血液稀释可使子宫颈癌根治术患者少输或不输异体血。     

ANIH对肿瘤患者围术期T淋巴细胞亚群和NK细胞的影响

目的探讨急性非等容量血液稀释（ANIH）对肿瘤患者围术期T淋巴细胞亚群及NK细胞的影响。方法将择期行直肠癌根治术（Mile’s）患者60例,随机分为3组,每组20例：Ⅰ组（不输血组）,Ⅱ组（输异体少白细胞红细胞组）,Ⅲ组（ANIH组）。于麻醉诱导前采血400～600ml,全麻诱导时快速输入2倍采血量的羟乙基淀粉,并于手术结束前或Hct﹤24%时将自体血予以回输。分别于麻醉前1h（T1）、术毕即刻（T2）、术后第1d（T3）、第4d（T4）抽取静脉血,测定T淋巴细胞亚群和NK细胞。结果与正常人群比较,T1时三组CD3＋、CD4＋、CD4＋/CD8＋和NK细胞水平均低于正常值（P〈0.01）,CD8＋水平增高（P〈0.01）。与T1时比较,T3时CD3＋、CD4＋和CD4＋/CD8＋水平三组均明显降低（P〈0.05）,Ⅰ组和Ⅱ组降低较Ⅲ组更明显（P〈0.05）;Ⅰ组和Ⅱ组组间差异无统计学意义（P〉0.05）,T4时三组均恢复至T1时水平,但Ⅰ组和Ⅱ组CD3＋、CD4＋和NK细胞均值较Ⅲ组低（P〈0.05）。结论直肠癌患者术前存在细胞免疫功能的抑制,ANIH对免疫抑制轻微,且术后免疫功能恢复快。急性非等容量血液稀释可作为肿瘤患者围术期血液保护的良好措施。     

急性高容量血液稀释联合控制性降压及自体血回输在脑膜瘤手术中的应用

目的 探讨急性高容量血液稀释（AHH）联合控制性降压和自体血回输对脑膜瘤的临床效果与安全性。 方法 选取2012年4月至2017年12月临汾市中心医院神经外科收治的40例择期脑膜瘤手术患者，参考随机数字表法分成观察组和对照组各20例。观察组全麻诱导后30 min内输入琥珀酰明胶 15 ml／kg。手术开始时用乌拉地尔行控制性降压，维持平均动脉压（65±5）mmHg，并用自体血液回收仪回收并回输术野出血。对照组除未行控制性降压外，其余操作均同观察组。两组术中连续监测心率、平均动脉压、中心静脉压；记录出血量、异体血输入量及手术时间，并分别于AHH前后、术毕测定血红蛋白、血细胞比容、pH值、碱剩余值。 结果 观察组失血量［（837±245）ml］和自体血回输量［（405±123）ml］均低于对照组［（1 197±295）ml］和［（593±247）ml］（P＜001）。两组血细胞比容、血红蛋白在AHH后和术毕较AHH前降低（P＜001），两组各时点pH值、碱剩余值无明显改变。观察组未输入异体血，对照组5例输入去白悬浮红细胞2 U，5例输注新鲜冰冻血浆400 ml。两组均未发生创面异常出血、肺水肿及心衰等并发症。 结论 AHH联合控制性降压可安全用于脑膜瘤手术，明显减少术中出血量，术中配合自体血回输技术可减少输血反应。     

接受自体或异体输血的前列腺癌根治术患者的术后复发

输血对癌症复发的影响令人关注.作者就自体或异体输血对前列腺癌根治术后存活时间和复发的影响进行了研究.前列腺癌患者309例,均由同一外科医师施行耻骨后前列腺癌根治术.围手术期输血指术中和术后1个月内输注某种血液成份.患者分为2组:Ⅰ组94例,仅接受异体血70例,输血量平均2.51单位;接受自体血和异体血24     

急性等容稀释在腹腔镜妇科恶性肿瘤根治手术中的应用

目的探讨急性等容稀释(ANH)在腹腔镜妇科恶性肿瘤根治手术中的效果。方法选取2012年4月至2014年4月间解放军第二〇二医院收治的行腹腔镜下妇科恶性肿瘤根治手术患者50例,采用随机数字表法分为急性等容血液稀释(ANH)组和对照组,每组各25例。ANH组患者在全身麻醉后用采血袋经静脉采血,同时经另一侧静脉输入晶体液或(和)胶体液,采集的血液在术中大出血基本控制后或手术结束前回输。对照组患者不采取特殊措施,如需要输血时从血库提取。结果两组患者在各时间点的平均动脉压、心率、血氧饱和度差异均无统计学意义(均P>0.05)。两组患者手术时间、麻醉时间、苏醒时间、拔除气管导管时间、术中出血量及术前和术后1d的血红蛋白、红细胞压积、血清肌酐浓度、血浆凝血酶原时间和血小板差异均无统计学意义(均P>0.05)。但输异体红细胞量及输血反应发生率差异均有统计学意义(均P<0.05)。结论在腹腔镜下妇科恶性肿瘤根治手术中应用ANH可以有效减少异体输血量和输血反应的发生。     

急性中度高容性血液稀释对坐位脑肿瘤手术病人血液动力学和电解质平衡的影响

目的　探讨应用不同液体进行急性中度高容性血液稀释对脑肿瘤坐位手术病人血液动力学和电解质平衡的影响。方法　选择坐位行脑肿瘤切除病人 2 0例 ,随机分成两组 (Ⅰ、Ⅱ ) ,Ⅰ组麻醉诱导后采用HES ,10mL/kg进行扩容 ,Ⅱ组麻醉诱导后采用乳酸林格氏液 10mL/kg进行扩容。然后均置病人坐位 ,观察病人坐位前后血液动力学、HCT和电解质平衡的改变。结果　Ⅰ组有效维持了血液动力学的平衡 ,血K 出现了稀释性下降 ,但仍维持在正常范围内 ;Ⅱ组扩容维持时间短 ,血K 未出现明显变化。结论　HES扩容能有效预防体位性低血压 ,但可引起K 稀释性下降     

急性中度高容性血液稀释对坐位脑肿瘤手术病人血液动力学和电解质平衡的影响

目的 探讨应用不同液体进行急性中度高容性血液稀释对脑肿瘤坐位手术病人血液动力学和电解质平衡的影响。方法 选择坐位行脑肿瘤切除病人20例，随机分成两组(Ⅰ、Ⅱ)，Ⅰ组麻醉诱导后采用HES，10mL／kg进行扩容，Ⅱ组麻醉诱导后采用乳酸林格氏液10mL／kg进行扩容。然后均置病人坐位，观察病人坐位前后血液动力学、HCT和电解质平衡的改变。结果 Ⅰ组有效维持了血液动力学的平衡，血K 出现了稀释性下降，但仍维持在正常范围内；Ⅱ组扩容维持时间短，血K 未出现明显变化。结论 HES扩容能有效预防体位性低血压，但可引起K 稀释性下降。     

自体输血在乳腺癌手术中的应用体会

目的：观察输自体血和异体血对乳腺癌病人术后生存率的影响，并了解其是否可能传播２血清性传染性疾病，方法：依照国际乳腺癌ＴＮＭ分期标准，选择１００例Ⅰ－Ⅱ期乳腺癌患者，分自自体输血组和异体输血组，每组５０例。自体输血是指术前一天采自体血２００－４００ｍｌ，于术回输给病人；异体输血是批术中输库存异体血。对比观察术中血压、脉搏情况和不良输血反应，并对术后病人进行随访。结果：自体输血组术中血压、脉搏平稳，术     

血液稀释自家输血在食管(贲门)癌根治术中的应用(附30例报告)

在30例食管(贲门)癌根治术中应用血液稀释自家输血的方法,临床效果良好。适应症为血红蛋白10g以上,红细胞压积35％以上,心肺肝肾功能健全,体质较好的患者。全组无并发症,不延长住院时间,均痊愈出院。30例中有19例(63％)术中、术后均未输用库血。全组平均每例库血用量为150ml,对照组为590.5ml。因此,在食管癌根治术中应用此法安全,有效。且可节省大量库血,减少或避免输同种库血的并发症,减轻病员经济负担,值得推广应用。     

子宫颈癌两种术前放疗方法近期疗效评价

近年来 ,有关手术和放射综合治疗子宫颈癌的报道不少 ,但多为术后对高危因素患者行术后照射[1,2 ] ,其利弊存有争议。我们对子宫颈癌术前照射后行宫颈癌根治术进行探讨 ,现将初步结果报告如下。一、材料与方法我院 1994年 1月～ 1996年 6月收治的 2 6 7例宫颈癌中 ,有 47例行术前放疗。年龄均 <6 5岁 ,中位年龄 47岁。无严重合并症及手术禁忌证。 47例中 ,临床Ⅰｂ期 7例 ,Ⅱａ期 16例 ,Ⅱｂ期 2 4例。鳞癌 2 6例 ,腺癌 15例 ,腺鳞癌 4例 ,透明细胞癌 2例。术前照射非随机分为两组 :体外放疗组 2 6例 ,其中Ⅰｂ期 1例 ,Ⅱａ期 6例 ,Ⅱｂ期 1…     

基于倾向性评分匹配法综合评价贮存式自体输血在肺癌手术患者中的临床应用效果北大核心

目的:综合评价贮存式自体输血(preoperative autologous blood donation,PABD)在肺癌手术患者中的临床应用效果。方法:回顾性分析2018年08月至2020年05月在我院行肺癌根治手术的患者共415例。其中80例采用贮存式自体输血(PABD组),335例未采用(No-PABD组)。采用倾向性评分匹配功能进行匹配,比较匹配后的两组患者的术中出血量、术中异体血输注量、输血不良反应、术后胸腔引流量、围术期的血红蛋白(Hb)、血小板(PLT)变化情况等指标。结果:采用1∶1最邻近匹配法,经倾向性评分匹配后成功匹配80对患者。PABD组采血后Hb、红细胞(RBC)、红细胞压积(Hct)水平均低于采血前,差异有统计学意义(P<0.05);而PLT水平在采血前后无统计学差异(P>0.05)。两组患者在术后1、3、7天的Hb和PLT变化基本一致,差异无统计学意义(P>0.05)。PABD组术中出血量[(474.9±325.9)mL vs(458.1±281.5)mL]、术后胸水引流量[(873.0±360.3)mL vs(774.5±341.7)mL]及住院时间[(9.4±3.3)d vs(9.8±2.6)d]与No-PABD组比较无明显差异(P>0.05)。而PABD组异体血输注量(4000 mL vs 8800 mL)、异体血输入率(8.8%vs 23.8%)及输血相关费用[(189.5±92.2)元vs(337.8±426.8)元]均低于No-PABD组。结论:贮存式自体输血在肺癌手术患者中的临床应用是安全的,可以降低异体血输入率,减少输血相关费用。     

Combined use of erythropoietin and granulocyte colony-stimulating factor does not decrease blood transfusion requirements during induction therapy for high-risk neuroblastoma: a randomized controlled trial.

PURPOSE: To evaluate the efficacy of recombinant erythropoietin (EPO) and granulocyte colony-stimulating factor (G-CSF) in reducing blood transfusion requirements and stimulating hematopoiesis in children with high-risk neuroblastoma. PATIENTS AND METHODS: Thirty-eight patients given six cycles of intensive induction chemotherapy for high-risk neuroblastoma were randomized to receive G-CSF (n = 20) or G-CSF + EPO (n = 18). Cytokines were given subcutaneously each day, starting 24 hours after each chemotherapy cycle and continuing until 48 hours before the start of the next cycle. The primary end point was the effect of EPO on total red cell transfusion requirements during induction therapy. RESULTS: Patients who received G-CSF + EPO had a higher red cell transfusion requirement (median, 161.0 mL/kg) than did those who received G-CSF alone (median, 106.6 mL/kg; P =.005). In addition, among patients given transfusions for hemoglobin < or = 8 g/dL, those in the G-CSF + EPO group received more red cell transfusions than did those given G-CSF alone (median per patient, 10 v 8, respectively; P =.044). The two treatment groups had similar cumulative durations of neutropenia, incidences of febrile neutropenia, platelet transfusion requirements, and numbers of platelet transfusions; they also received induction chemotherapy for similar durations and had similar probabilities of progression-free survival and overall survival. CONCLUSION: The addition of EPO to the G-CSF regimen provides no benefit for patients receiving intensive induction chemotherapy for high-risk neuroblastoma.     

乳腺癌的不输血手术治疗

目的：探讨乳腺癌不输血手术治疗的可行性,方法：我院１９９４年１月至２０００年６月,３２１例乳腺癌患者施行乳腺极治性切除术,不预输血。其中根治术１９６例,改良根治术１２１例,双侧根治术４例,在创口合、体质状况恢复等方面进行分析。结果：３２１例乳腺癌患者行乳房根治术治疗,平均每例失血约１８５ｍｌ,仅有４３例用代血浆（血安定,贺期）,无１例输血和使用血制品,平均术后住院天数１１．８天,与围手术期输血者相比,在创口愈合,术后并发症,体质恢复等方面无明显差异,结论：对乳腺癌患者施行不输血乳房根治性切除术是可行的。     

Perioperative blood transfusion in hepatocellular carcinomas: influence of immunologic profile and recurrence free survival

BACKGROUND: The postoperative recurrence of hepatocellular carcinomas (HCC) associated with perioperative blood transfusion has been the subject of controversy. The authors prospectively investigated the relation between perioperative allogeneic blood transfusions, the recurrence free survival, and the immunologic profiles of patients with HCC who had undergone curative hepatic resections. METHODS: One hundred eight patients were divided into two groups: a transfused group (n = 53) and a nontransfused group (n = 55), according to their perioperative transfusion history. The subsets of lymphoid cells, natural killer cell activity and the phytohemagglutinin (PHA) response were all measured preoperatively, and at 1, 2, and 4 weeks and at 3 and 6 months after the hepatectomy. The recurrence free survival rate then was compared between these two groups. RESULTS: There were no significant differences between these two groups with respect to histologic findings, clinical stage, type of resection, pathologic data, and the recurrence free survival rate. Postoperative levels of the CD8 in the transfused group were elevated as compared with the nontransfused group, and the PHA response of the transfused patients was significantly increased at 7 postoperative days. Natural killer cell activity of the transfused patients was decreased at 7 postoperative days, as compared with the nontransfused patients, but there was no significant difference. CONCLUSIONS: Although allogeneic blood transfusion may have immunosuppressive effects, perioperative blood transfusions did not influence the cancer free survival rate in patients with hepatocellular carcinoma.     

Acute Normovolemic Hemodilution Effects on Perioperative Coagulation in Elderly Patients Undergoing Hepatic Carcinectomy

Background: Acute normovolemic hemodilution (ANH) has been widely used to prevent the massive bloodloss during hepatic carcinoma. The influences of ANH on coagulation function are still controversy, especiallyin elderly patients. The study observed ANH effects on coagulation function and fibrinolysis in elderly patientsundergoing the disease. Materials and Methods: Thirty elderly patients (aged 60-70 yr) with liver cancer (ASAⅠ or Ⅱ) taken hepatic carcinectomy from February 2007 to February 2008 were randomly divided into ANHgroup (n=15) and control group (n=15). After tracheal intubation, patients in ANH group and control groupwere infused with 6% hydroxyethyl starch (130/0.4) and Ringer’s solution, respectively. Blood samples weredrawn from patients in both groups at five different time points: before anesthesia induction (T1), 30 min afterANH (T2), 1 h after start of operation (T3), immediately after operation (T4), and 24 h after operation (T5).Then coagulation function, soluble fibrin monomer complex (SFMC), prothrombin fragment (F1+2), and plateletmembrane glycoprotein (CD62P and activated GP IIb/GP IIIa) were measured. Results: The perioperativeblood loss and allogeneic blood transfusion were recorded during the surgery. The perioperative blood loss wasnot significantly different between two groups (p>0.05), but the volume of allogeneic blood transfusion in ANHgroup was significantly less than in control group (350.0±70.7) mL vs. (457.0±181.3) mL (p<0.01). Comparedwith the data of T1, the prothrombin time (PT) and activated partial thromboplastin time (APTT) measuredafter T3 were significantly longer (p<0.05) in both groups, but within normal range. There were no significantchanges of thrombin time (TT) and D-dimer between two groups at different time points (p>0.05). SFMC andF1+2 increased in both groups, but were not statistically significant. PAC-1-positive cells and CD62P expressionsin patients of ANH group were significantly lower than those at T1 (p<0.05) and T2-T5 (p>0.05). Conclusions:ANH has no obvious impact on fibrinolysis and coagulation function in elderly patients undergoing resection ofliver cancer. The study suggested that ANH is safe to use in elderly patients and it could reduce allogeneic bloodtransfusion.     

骶骨肿瘤外科切除术中应用腹主动脉球囊导管低位阻断术的效果观察

目的:探讨骶骨肿瘤外科切除术中应用腹主动脉球囊导管低位阻断术的效果。方法:选取抚矿总医院骶骨肿瘤手术切除100例病例，随机等分为两组，术前分别给予A组球囊导管阻断术控制血流，B组动静脉置管麻醉，降低血压，观察术中出血量、输血量、手术时间，术中出血量与术后复发变化规律。结果:所选病例中A组术中出血量、术中输血量、手术时间均明显少于B组，有统计学意义（均P＜0.05）；术中出血量A组小于2 500 ml病例肿瘤复发率低于B组大于2 500 ml病例，两者比较有显著性差异(P＜0.05)。结论:腹主动脉球囊导管低位阻断术在骶骨肿瘤切除术中可以获得满意效果。     

控制性低中心静脉压对肝切除术患者肾功能的影响

Objective： To investigate the effects of low central venous pressure （LVCP） on blood loss and evaluate its influence on renal function in patients undergoing hepatectomy. Methods： Forty-six patients, ASA classification Ⅰ-Ⅲ, undergoing liver resection were randomized into LCVP group （n = 23） and control group （n = 23）. In LCVP group, CVP was maintained at 2-4 mmHg and MBP above 60 mmHg during hepatectomy, while in control group hepatectomy was performed routinely without lowering CVP. Volume of blood loss during hepatectomy, volume of blood transfusion, and changes of renal functions were compared between the two groups. Results： There were no significant differences in demographics, ASA score, type of hepatectomy, duration of inflow occlusion, operation time, weight of resected liver tissues, and renal functions between the two groups. LCVP group had a significantly lower volume of total intraoperative blood loss （P 〈 0.01） and RBC transfusion （P 〈 0.05）. Conclusion： Lowering the CVP to less than 5 mmHg is a simple and effective technique to reduce blood loss and blood infusion during liver resection, and has no detrimental effects on renal functions.     

电视胸腔镜辅助下小切口肺癌手术的临床研究

背景与目的：在世界范围内，胸腔镜下行肺叶切除术治疗肺癌的相关经验正在逐渐积累。很多医学中心可在胸腔镜下完成解剖学上彻底的肺叶切除和淋巴结清扫。一些胸外科医师关注该类手术方式治疗肺癌的安全性、益处和根治性。我们的研究旨在探讨电视胸腔镜辅助小切口根治性肺癌切除的可行性。方法：电视胸腔镜辅助小切口下实施肺叶切除合并淋巴结清扫治疗原发性非小细胞肺癌32例，运用常规开胸手术器械及胸腔镜用器械切除肺叶，结合特殊的淋巴结摘除钳完成淋巴结清扫，并与同期40例肺癌常规开胸手术进行比较研究。结果：胸腔镜组32例肺癌手术顺利，出血少，均无输血，无严重并发症，术后恢复快。与常规组比较在手术时间、术后拔管时间和淋巴结清扫数量、范围无显著差异；术中出血量、术后住院天数胸腔镜组明显优于常规组。结论：电视胸腔镜辅助小切口下肺癌手术安全可行，创伤小，符合肺癌手术原则，长期疗效有待随访观察。