梗阻性黄疸病人手术前后血清白细胞介素2受体和白细胞介素6的变化及意义

材料和方法 :36例梗阻性黄疸病人 ,男 2 1例 ,女 15例 ,年龄 2 5～ 6 8岁 ,平均 5 2 6岁 ,胆管结石所致的良性黄疸 2 0例 ,恶性梗阻性黄疸 16例 (胰头癌 2例 ,胆管癌 10例 ,十二指肠乳头癌2例 ,肝门部转移癌 2例 ) ,均外科手术及病理学诊断 ;对照组为性别 ,年龄与病人无明显差异的健康献血者。检测方法 :清晨空腹抽肘静脉血6ｍｌ即时离心分离血清后置 - 2 0℃冷冻待检 ,要求血清无溶血 ,脂浊。ｓＩＬ 2Ｒ和白细胞介素 6 (ＩＬ 6 )采用深圳晶美生物工程有限公司提供的ＥＬＩＳＡ试剂测定。治疗方法 :全部病人均手术解除胆道梗阻 (11例Ｔ管引…     

曲马多术后镇痛对腹腔镜胆囊切除术患者血清白细胞介素-2和白细胞介素-6水平的影响

目的 研究通过曲马多用于腹腔镜胆囊切除术患者静脉自控镇痛(patient-controlled intravenous analgesia,PCIA),观察其术后视觉模拟评分(visual analogue score,VAS),镇静(Ramsay)评分以及对血清白细胞介素-2(IL-2)及白细胞介素-6(IL-6)水平的影响,探讨曲马多用于静脉自控镇痛效果及对机体免疫功能的影响.方法 选择40例行择期腹腔胆囊切除术的的患者,ASA Ⅰ或Ⅱ级,用信封法随机分为两组,每组20例:Ⅰ组(芬太尼组),Ⅱ组(曲马多组).观察记录术后2、4、24 hVAS评分,Ramsay评分,以及血清IL-2,IL-6水平,并记录副作用. 结果 两组患者术后2、4、24 hVAS、Ramsay评分、PCIA有效按压次数差异无统计学意义(P＞0.05).与诱导前比较Ⅰ组为(12.4±2.0),Ⅱ组为(12.1±2.1),Ⅰ、Ⅱ组血清IL-2水平术后2h明显升高,Ⅰ组为(16.8±2.4),Ⅱ组为(17.4±2.6)(P＜0.05),持续至术后24 h(P＜0.05),两组组间比较差异无统计学意义(P＞0.05).与诱导前比较,Ⅰ、Ⅱ组血清IL-6水平比较差异无统计学意义(P＞0.05),两组患者术后不同时间点血清IL-6水平比较差异无统计学意义(P＞0.05). 结论 与本研究中芬太尼剂量相比,曲马多用于腹腔镜胆囊切除手术术后镇痛能产生良好的镇痛效果,促进机体的免疫功能并有效地抑制术后应激反应.     

自体输血对心脏外科手术病人血小板白细胞及纤溶系统的影响

目的：探讨自体输血对心脏直视手术病人血小板、白细胞及纤溶系统的影响。方法：24例体外循环心脏手术病人分为两组，试验组11例，接受自体红细胞洗涤回输；对照组13例，不接受自体血细胞洗涤回输。于术前、血液洗涤前、洗涤后即刻、回ICU后3h、12h测定纤维蛋白原、D－二聚体（D－D）、血栓素A2（TXA2）、白介素（IL）－6、IL－8。结果：术后两组间纤维蛋白原、D－D、TXA2、IL－6、IL－8等指标差异无统计学意义。结论：心脏直视手术过程中，自体血液洗涤不会进一步激活血小板、白细胞及纤溶系统而增加相关并发症。     

胆道梗阻患者血清白细胞介素-2和可溶性白细胞介素-2受体水平及精氨酸治疗的研究

为探讨白细胞介素-2(IL-2)／可溶性白细胞介素-2受体(SIL-2R)系统平衡紊乱对胆道梗阻患者免疫状况的影响，我们对胆道梗阻患者围手术期血清IL-2活性和SIL-2R表达状况及精氨酸的免疫调节作用进行分析，报告如下。     

慢性肾小球肾炎患者中医证型与血、尿白细胞介素-2、可溶性白细胞介素-2受体关系

慢性肾小球肾炎 (ＣＧＮ)免疫功能紊乱已得到公认 ,但这种免疫功能紊乱与中医证型的相关性尚未得到统一认识。为了探讨ＣＧＮ不同证型的细胞免疫改变以及与各证型间的相关性 ,笔者选择了 49例ＣＧＮ患者 ,观察血、尿白细胞介素 - 2 (ＩＬ - 2 )、可溶性白细胞介素 - 2受体 (ｓＩＬ -2Ｒ)的变化 ,报道如下。资料与方法1　研究对象　本文 49例慢性肾小球肾炎病人均符合1992年《中华内科杂志》编委会肾病小组“原发性肾小球疾病分型与治疗及诊断标准” ,[1] 中医辨证参照全国第 2次中医肾病学术会议“慢性肾炎中医辨证分型标准”。[2 ] 其中肺…     

滤除白细胞自体回收血对围术期患者红细胞免疫功能及全身炎症反应的影响

目的 评价滤除白细胞自体回收血对围术期患者红细胞免疫功能及全身炎症反应的影响.方法 选择术中行回收式自体输血患者20例,年龄20～44岁,体重40～75 kg,ASA分级Ⅰ或Ⅱ级,预计失血量15～20 ml/kg,采用随机数字表法,将患者随机分为两组(n=10):对照组(C组)和滤除白细胞组(D组).C组进行常规自体血回收回输,D组自体血滤除白细胞后再输给患者.两组患者分别于麻醉前(T1)、术毕(T2)、术后12 h(T3)、36 h(T4)时采集中心静脉血标本,采用改良郭峰法检测红细胞C3b受体花环率、红细胞免疫复合物花环率,并行白细胞及中性粒细胞计数;ELISA法检测血浆TNF-α、IL-6、NDA浓度.结果 与C组比较,D组T2-4时血浆IL-6、TNF-α、MDA浓度降低,T3,4时红细胞C3b受体花环率升高(P＜0.01),T4时中性粒细胞计数降低(P＜0.05).结论 滤除白细胞自体回收血有助于改善围术期患者红细胞免疫功能,其机制可能与降低全身炎症反应有关.

Abstract：

Objective To investigate the effect of leukocyte-depleted intraoperative salvaged blood on the erythrocyte immunity and systemic inflammatory response during the perioperative period in patients. Methods Twenty ASA Ⅰ or Ⅱ patients, aged 20-44 yr, weighing 40-75 kg, required blood salvage during operations (intraoperative blood loss expected 15-20 ml/kg), were randomly divided into 2 groups ( n = 10 each): control group (group C) and leukocyte depletion group (group D) . Anesthesia was induced with midazolam, fentanyl, propofol and vecuronium and maintained with isoflurane inhalation and iv infusion of propofol and remifentanil. The patients were mechanically ventilated after tracheal intubation. Intraoperative blood salvage and reinfusion were performed in all patients using cell saver system. In group D, the salvaged blood was filtered with a leukocyte depleting filter placed in the line of the reinfusion circuit. Blood samples were collected from the central vein before anesthesia (T1 ) , at the end of surgery (T2 ) , and at 12 h (T3 ) and 36 h (T4 ) after operation in the two groups. The rosette rates of RBC-C3b receptors and RBC-immune complex were determined. The leukocyte and neutrophil were counted. The plasma levels of interleukin-6 (IL-6), tumor necrosis factor-alpha (TNF-α) and malondialdehyde (MDA) were measured. Results The plasma levels of IL-6, TNF-a and MDA were significantly lower at T2-4 , the rosette rate of RBC-C3b receptors was significantly higher at T3-4 ( P ＜ 0.01) , and the neutrophil count was significantly lower at T4 in group D than in group C ( P ＜ 0.05) . Conclusion Leukocyte-depleted intraoperative salvaged blood is helpful to improve the erythrocyte immunity during the perioperative period in patients, and the decrease in the systemic inflammatory response may be involved in the mechanism.     

消炎痛对阻塞性黄疸患者外周血淋巴细胞白细胞介素-10、白细胞介素-2水平的影响

目的研究阻塞性黄疸患者外周血淋巴细胞白细胞介素-10(IL-10)、白细胞介素-2(IL-2)水平和血浆中前列腺素E2(PGE2)水平的变化,同时观察消炎痛对上述指标的影响。方法给阻塞性黄疸患者口服消炎痛(25mg,1次/8小时),用药前和用药后7d取外周血,分别用放射免疫和ELISA法测血浆中PGE2水平及外周血淋巴细胞IL-10、IL-2水平。结果用药前阻塞性黄疸患者血浆中PGE2水平及外周血淋巴细胞IL-10水平较正常人明显升高,而IL-2水平明显下降,且IL-10、IL-2的水平与PGE2水平显著相关;用药后,患者血淋巴细胞IL-2水平明显升高,而IL-10水平及血浆中PGE2水平明显下降,与用药前相比差异有统计学意义。结论阻塞性黄疸患者淋巴细胞IL-10、IL-2水平的变化与其血浆中PGE2水平升高有关,消炎痛能够明显缓解这种作用。     

罗比卡因-芬太尼术后镇痛对乳腺癌患者患者白细胞介素-2和白细胞介素-6的影响

目的探讨罗比卡因复合芬太尼行硬膜外自控镇痛(PCEA)对乳腺癌患者术后白细胞介素-2(IL-2)和白细胞介素-6(IL-6)的影响。方法40例乳腺癌根治术患者随机分为两组,每组20例。Ⅰ组为罗比卡因复合芬太尼组;Ⅱ组为罗比卡因复合吗啡组。分别于麻醉前(T0)、术后2h(T1)、24h(T2)、72h(T3)采集外周静脉血,测定T淋巴细胞亚群及IL-2、IL-6水平。结果两组镇痛效果良好,与麻醉前比较,Ⅰ组T淋巴细胞亚群及IL-2水平各时点之间无显著性差异(P>0·05);与Ⅰ组比较,Ⅱ组T1、T2时的CD3+、CD4+、IL-2均明显下降(P<0·05)。结论罗比卡因复合芬太尼行PCEA效果良好,对免疫的抑制作用较轻,适合乳腺癌患者术后镇痛。     

自体血回输及异体输血前后病人血浆IL-2及IL-6的变化

目的 比较全麻下骨科手术自体血回输及异体输血对病人血浆白介素－2（IL－2）及白介素－6（IL－6）的影响。方法 57例骨科病人，随机分为两组：Ⅰ组，自体血回输，31例：Ⅱ组，异体输血，26例。两组均于麻醉前、术后第2天、第7天采外周静脉血3ml，肝素抗凝离心后取血浆冷冻备检测。结果 术后第2天，Ⅱ组IL－2较术前及Ⅰ组明显下降（P＜0.05）；IL－6在术后第2天、第7天两组病人都有升高；术后第2天Ⅰ组较术前和Ⅱ组升高非常显著（P＜0.01），术后第7天Ⅰ组升高显著（P＜0.05）。结论 自体血回输组病人IL－2下降不明显，IL－6明显升高，对病人的免疫功能影响较小；异体输血组IL-2明显下降，IL－6升高不显著，对病人的免疫功能有一定的抑制作用。     

骨科手术中自体血液回输对血清前炎性细胞因子浓度的影响

目的 测定下肢骨科手术术野回收血经自体血回收机处理前后及患者自血回输前后血清前炎性细胞因子浓度,观察骨科手术中自体血回输对患者细胞免疫的影响.方法 30例择期行下肢骨科手术患者,分别采集自体血回收机处理前后的术野回收血,并于自体血回输前10min、回输后1 h采集患者动脉血,采用放射酶联免疫吸附测量法测定血样中3种前炎性细胞因子白细胞介素(IL)-1β、IL-6、肿瘤坏死因子(TNF)浓度,并观察相关并发症.结果　术野回收血经自体血回收机处理前后3种前炎性细胞因子IL-1β、IL-6、TNF浓度分别为(0.54 ±0.22)、(0.71±0.16)、(16.23±5.68)μg/L和(0.26±0.12)、(0.29±0.09)、(6.32±2.57)μg/L,与处理前比较,处理后3种细胞因子浓度显著降低(P＜0.05);自血回输前后患者血清中3种细胞因子IL-1β、IL-6、TNF浓度分别为(0.35±0.17)、(0.47±0.15)、(8.44±3.56)μg/L和(0.39±0.19)、(0.52±0.18)、(9.48±3.45)μg/L,与回输前比较,回输后患者血清中3种细胞因子浓度增高(P＜0.05);30例患者自体血回输后12 h内均未观察到低血压、心动过速、血红蛋白尿、凝血功能紊乱、脓毒血症、空气栓塞、心肺问题等并发症.结论　骨科手术患者术中可适量自体血回输,回收血液经自体血回收机处理后前炎性细胞因子浓度显著降低,回输后未观察到严重并发症.

Abstract：

Objective To investigate the effects of autologous blood transfusion on serum cytokine levels in patients undergoing lower limb orthopedic surgery. Methods A total of 30 cases scheduled for undergoing lower limb orthopedic surgery were enrolled in this study. Each patient had four blood samples taken (pre-transfusion, one h post-transfusion, cell saver container, and post-filtration from the blood bag). An enzyme linked immunosorbent assay (ELISA) measurement of radiation was conducted to determine levels of the cytokines interleukin (IL)-1β, IL-6 and tumor necrosis factor (TNF). Serious complications and sequelae associated with autotransfusion were recorded. Results In comparison to cell saver container, levels of IL-1β, IL-6 and TNF in the blood bag were decreased significantly (P＜0. 05 ). In comparison to pre-transfusion, levels of IL-1β, IL-6 and TNF were increased significantly (P ＜ 0. 05 ). No serious complications and sequelae associated with autotransfusion were observed. Conclusion The use of cell saver container appears to be safe in patients undergoing orthopedic surgery and the levels of the cytokines in post-filtration blood are decreased.     

脊柱内固定术患者自体血液回收-回输后氧代谢的变化

目的评价自体血液回收-回输对脊柱内固定术患者氧代谢的影响。方法40例行脊柱内固定手术病人随机分为两组:自体血液回收-回输组(A组,n=20);等量异体血液输入组(B组,n=20)。分别在麻醉前、输入自体血或等量异体血后、术毕时及术后1d,采集血液动力学和血气分析数据,计算心脏指数(CI)、氧供(DO2)、氧耗(VO2)、氧摄取率(ERO2),并测定血液乳酸(LA)浓度。结果与麻醉前相比,两组输血后、术毕时DO2升高(P<0.05),其他指标各时点差异无统计学意义(P>0.05)。与B组比较,术毕时A组ERO2降低(P<0.05),在各时点DO2、VO2差异无统计学意义,LA差异也无统计学意义,且数值均在正常范围内。结论自体血液回收技术在一定的出血范围之内,可以满足脊柱内固定术患者机体氧代谢的需求。     

Frequency of homologous blood transfusion in patients undergoing cleft lip and palate surgery

Aim:

The study aims to determine the frequency of homologous blood transfusion in patientsundergoing cleft lip and palate surgery at the Lagos University Teaching Hospital, Nigeria.

Setting and Design:

A prospective study of transfusion rate in cleft surgery conducted at the Lagos University Teaching Hospital, Nigeria.

Material and Methods:

One hundred consecutive patients who required cleft lip and palate surgery were recruited into the study. Data collected included age, sex and weight of patients, type of cleft defects, type of surgery done, preoperative haematocrit, duration of surgery, amount of blood loss during surgery, the number of units of blood cross-matched and those used. Each patient was made to donate a unit of homologous blood prior to surgery.

Results:

There were 52 females and 48 males with a mean age of 64.4 ± 101.1 months (range, 3-420 months). The most common cleft defect was isolated cleft palate (45%) followed by unilateral cleft lip (28%). Cleft palate repair was the most common procedure (45%) followed by unilateral cleft lip repair (41%). The mean estimated blood loss was 95.8 ± 144.9 ml (range, 2-800ml). Ten (10%) patients (CL=2; CP=5, BCL=1; CLP=2) were transfused but only two of these were deemed appropriate based on percentage blood volume loss. The mean blood transfused was 131.5 ± 135.4ml (range, 35-500ml). Six (60%) of those transfused had a preoperative PCV of < 30%. Only 4.9% of patients who had unilateral cleft lip surgery were transfused as compared with 50% for CLP surgery, 11% for CP surgery, and 10% for bilateral cleft lip surgery.

Conclusions:

The frequency of blood transfusion in cleft lip and palate surgery was 10% with a cross-match: transfusion ratio of 10 and transfusion index of 0.1. A "type and screen" policy is advocated for cleft lip and palate surgery.     

Rh(D)阴性血型病人剖宫产术中成分式自体输血的安全性

目的 评价Rh(D)阴性血型病人剖宫产术中成分式自体输血的安全性.方法 拟行剖宫产术的Rh(D)阴性血型病人30例,年龄20～35岁,体重50～80 kg,ASA分级Ⅰ或Ⅱ级.静脉输注乳酸钠林格氏液7 ml/kg后经桡动脉采血,采血速率60～80 ml/min,采血同时静脉输注与采血等速率的6%羟乙基淀粉130/0.4.采集的自体血经2个循环的直接法分离为富含血小板血浆、贫血小板血浆和浓缩红细胞,每个循环以分离出红细胞后15 s时停止采血.出血量≥全身血容量的20%时立即回输自体血;出血量<全身血容量20%者,在缝合子宫后回输,依次回输富含血小板血浆、输贫血小板血浆和输浓缩红细胞.监测母体生命体征指标和胎儿心率.记录自体血采集过程中低血压和心动过速的发生情况.分别于采血前(基础状态)、采血结束时、自体血回输前和术后24 h时采集外周静脉血样,测定Hb、Hct、Plt、PT、APTT、INR和Fib.胎儿娩出后采集脐动脉血样,进行血气分析.于胎儿娩出后1、5min时行Apgar评分.记录术中出血量和异体输血情况.结果 自体血采集过程中未见低血压和心动过速的发生,胎儿HR维持在正常范围.与基础状态比较,其他时点SpO2、Hb、Hct、Plt、PT、APTT、INR和Fib差异无统计学意义(P>0.05).脐动脉血pH值、BE和乳酸浓度均在正常范围内.胎儿娩出后1、5 min时Apgar评分分别为(9.0±0.8)、(9.2±0.8)分;术中出血量(405±28)ml,所有病人未输注异体血.结论 Rh(D)阴性血型病人剖宫产术中成分式自体输血的安全性良好.

Abstract：

Objective To investigate the safety of autologous blood component transfusion during cesarean section in patients with Rh (D)-negative blood group.Methods Thirty ASA Ⅰ or Ⅱ patients of Rh (D)-negative blood group, aged 20-35 yr, weighing 50-80 kg, undergoing elective cesarean section, were enrolled in this study.After lactated Ringer' s solution 7 ml/kg was infused, blood was obtained from radial artery at a rate of 60-80ml/min, and blood volume was maintained by simultaneous infusion of 6% hydroxyethyl starch 130/0.4 at the same rate. The collected blood was subjected to two cycles of autologous blood component separation. Blood collecting during each cycle was stopped 15 s after red blood cells were separated. The autologous blood was infused when the blood loss≥20% of blood volume. The autologous blood was infused after suture of the uterus when the blood loss < 20% of blood volume. The parameters of maternal vital signs and fetal heart rate were monitored. Hypotension and tachycardia were recorded during autologous blood collecting. SpO2 was monitored routinely. Venous blood samples were taken before blood collecting (baseline), at the end of blood collecting, before autologous blood transfusion, 24 h after operation for determination of Hb, Hct, Plt, PT, APTT, INR and Fib. Umbilical arterial blood samples were obtained after delivery for blood gas analysis. Apgar score was recorded at 1 and 5 min after birth. Blood loss and allogeneic blood transfusion were also recorded. Results No hypotension and tachycardia occurred during the process of blood collecting and the fetal heart rate was within the normal range. Compared with the baseline value, there were no significant differences in SpO2 , Hb, Hct, Plt, PT, APTT, INR and FIB value at the other time points. The pH value and concentrations of base excess and lactate were within the normal range.The Apgar score was (9.0 ±0.8) and (9.2 ± 0.8) at 1 and 5 min after birth respectively. The blood loss during operation was (405 ± 28) ml and no patients received homologous blood transfusion. Conclusion The safety of autologous blood component transfusion is good during cesarean section in Rh (D)-negative blood group patients.     

川芎嗪对自体血回输患者围术期体液免疫功能的影响

目的 探讨川芎嗪对自体血回输患者围术期体液免疫功能的影响.方法 择期行脊柱手术患者60例,年龄20～60岁,体重50 ～ 75 kg,ASA分级Ⅰ或Ⅱ级,采用随机数字表法,将患者随机分成2组(n=30),试验组:于收集自体血前30 min,经5 min静脉输注川芎嗪2mg/kg,并在回收血液的肝素盐水和洗涤盐水内加入川芎嗪,每500 ml加入川芎嗪25 mg;对照组不给予川芎嗪.于麻醉诱导前(T0)、术后1 h(T1)、1 d(T2)及5 d(T3)时取静脉血样,采用ELISA法测定血清免疫球蛋白(IgG、IgM)的浓度;记录手术时间、术中出血量、回输血量.结果 两组患者手术时间、术中出血量、回输血量比较差异无统计学意义(P＞ 0.05).与T0时比较,对照组T1～T3时血清IgG和IgM浓度降低,试验组T1、T2时血清IgG浓度降低(P＜0.05或0.01),T3时差异无统计学意义,T1～T3时血清IgM浓度差异无统计学意义(P＞0.05);与对照组比较,试验组T2、T3时血清IgG浓度、T1～T3时血清IgM浓度升高(P ＜0.05或0.01).结论 川芎嗪可在一定程度上减轻自体血回输患者体液免疫抑制,改善体液免疫平衡状态.     

创伤患者血清新喋呤的变化及临床意义

目的探讨创伤后血清新喋呤的变化规律及其临床意义.方法创伤患者41例,根据损伤严重度评分将患者分为3组轻伤组10例,重伤组16例,严重伤组15例.于入院后第1、3、7、14、21天取血测定血清新喋呤含量,并分析新喋呤水平与患者伤情、严重并发症及预后的关系.结果严重伤组新喋呤水平高于轻伤组(P＜0.05或P＜0.01),其均值与损伤严重度评分呈显著正相关(r=0.518,P＜0.05).自伤后第3天起创伤后并发多器官功能障碍综合征(MODS)者新喋呤水平持续升高,其中第3、7、14天与未出现MODS者相比差异有显著性意义(P＜0.05或P＜0.01).同时,严重创伤后死亡组患者新喋呤升高幅度亦明显大于存活组,患者死亡前其血清含量多超过50.0nmol/L(8/12,66.7%).结论创伤应激后体内新喋呤合成、释放增多,动态观察循环新喋呤改变可能有助于评价患者损伤程度、监测MODS病理过程和辅助判断预后等.     

围手术期输血对恶性肿瘤患者的影响

输血可以促进肿瘤患者术后复发,并且降低5年生存率.即使是处于肿瘤早期,少量输血也有明显影响.输血引起肿瘤复发的机制可能是由于输血抑制了受血者的免疫功能,从而使残余肿瘤细胞得以迅速增长.本文就肿瘤患者围手术期输血的几个相关问题进行探讨,提出如何权衡输血对肿瘤患者的利弊,以及在肿瘤患者输血中如何进行自体输血和血液替代品的应用,从而严格掌握肿瘤患者输血指征,提高输血治疗的质量.     

肝移植术麻醉中自体血液回输技术的应用

目的 探讨肝移植术中应用自体血液同输技术的安伞性和效果.方法 选择行原化肝移植术患者46例,根据是否符合自体血回输标准分为两组:回输组和对照组,每组23例.回输组术中应用自体血液回收机进行血液收集、回输,观察其效果.分别于麻醉前、无肝前期、无肝期、新肝期、术毕等时点采血样,测定红细胞汁数(RBC)、血红蛋白(Hb)、血小板(Plt)、血细胞比容(Hct)、凝血酶原时间(PT)、活化部分凝血酶时间(APTT)、纤维蛋白原含量(FIB)及国际标准化比值(INR).结果 回输组每例回输自体血(2 613±1 637)ml,输入异体浓缩红细胞量显著少于对照组(P＜0.01),两组间各时点RBC、Hb,Plt、Hct、PT、APTT、FIB、INR差异无统计学意义.结论 肝移植术中应用自体血液叫输技术能及时回收失血,维持有效循环,显著减少异体血输入.     

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目的 观察老年人术前储存式自体输血的临床效果。方法 自决定放行储存式自体输血之日起,入选病例每天口服多糖铁１５０ｍｇ,每日２次,采血前１小时控予采血量的３倍给予晶、胶液体（晶、胶液体量比例为２：１）经外周静脉输入,然后经另一侧静脉采血,每次采血４００ｍｌ,同隔７２小时采血１次,部采血量不应超过１２００ｍｌ。结果 除２例病人因术中失血量过多同时输注异体血外,其余病人均未用异体血,其余病人均未恢复良好