储存式自体输血在体外循环心脏瓣膜置换术患者中的应用效果

目的:探究储存式自体输血对体外循环心脏瓣膜置换术患者凝血功能、氧合状况及细胞免疫功能的影响.方法:选取2017年1月至2020年6月在航天中心医院进行体外循环心脏瓣膜置换术患者130例,按输血方式不同分为对照组(n=65)与观察组(n=65).对照组进行异体输血,观察组进行储存式自体血回输.对比两组手术一般情况,术前1...     

自体血逆预充技术在儿童体外循环中的血液保护作用

目的在使用目前儿童体外循环管路基础上,探讨自体血逆预充技术用于儿童体外循环对血液保护作用。方法选取60例体重在20～40kg之间体外循环下行择期心脏手术先心病患儿,分为自体血逆预充组（Rap组,n=30）和标准预充组（SP组,n=30）。自体Rap组在转机前进行Rap操作,对照组常规预充转机。记录所有患儿的一般临床资料、手术情况、术后监护室情况、不同时刻患儿红细胞压积（hematocrit,Hct）和围术期用血量。结果两组患儿一般资料和手术情况差异无统计学意义（P〉0.05）;Rap组预充液量明显减少（P〈0.05）;阻断升主动脉后10min时RAP组患儿Hct高于对照组（P〈0.05）;Rap组术中用血量和输血率均少于SP组,但差异无统计学意义（P〉0.05）,两组患儿术后恢复情况相比较差异无统计学意义（P〉0.05）。结论Rap技术用于儿童体外循环可以减少预充量,保持转机过程中较高的Hct。但对血液保护作用不明显,目前用于临床的儿童体外循环管路有待于进一步改进。     

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。     

贮存式自体输血在外科手术中的应用效果

自体输血就是在患者需要输血时,输入病人自己预先储存的血液或者在手术过程中失血回收的血液,一般适合择期手术的病人。自体输血是一种科学合理、安全易行、经济的输血方法,包括预存、稀释、回收三种方式,该法具有可以减少异体血用量、节约血源、减少输血反应及输血传播疾病等优点。     

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。     

植骨材料在脊柱侧凸手术中的应用

自19世纪60年代Harrington系统出现以来,为脊柱侧凸患者的治疗带来了福音。随着研究的深入,人们逐渐认识到脊柱侧凸的治疗不能仅限于器械内固定,更关键在于手术矫形后的融合,否则即使再完美的手术     

血液回输技术在脊柱侧弯手术中的应用

探讨血液回输技术在脊柱侧弯手术的应用价值 ,我们将 2 6例脊柱侧弯矫正术病人分为两组 ,均在全麻后行手术 ,A组 :术中输库存血 :B组 :术中使用洗涤式血液回收机回收术中失血 ,以洗涤红细胞的形式回输 ,术中部分或不输入库存血 ,血液回收以后回输及输库存血皆未出现输血并发症。研究结果表明 ,在脊柱侧弯矫正术中应用术中自体血液回输措施可有效减少输入库存血 ,降低住院费用 ,可安全应用于临床。     

小型猪与家犬在手术教学中的对比分析

目的 比较两种动物用于手术教学的效果。方法 将成年杂种犬与小型猪麻醉后,一周一次依次对其施行切开缝合术、气管切开术、静脉切开术、臀部清创术和盲肠部分切除术,比较分析猪与犬的一般特性、麻醉、切口愈合情况以及死亡率。结果 猪对人的健康安全威胁较小,更能耐麻药,伤口甲级愈合率较高,死亡率较低。结论 小型猪用于学生手术教学优于犬。     

预存式自体输血在稀有血型及产后出血高危孕妇中的应用

输血是解决产后出血这一难题不可替代的治疗手段.由于输血技术的广泛应用,同种异体输血的安全问题和血资源紧张问题日益突出.为降低同种异体输血风险,缓解血源短缺问题,预存式自体输血(preoperative autologous blood donation,PABD)逐步应用于临床,现对PABD在产科应用的研究进展作一综述...     

Factors associated with successful autologous blood donation for elective surgery.

Not all donors can donate the number of autologous blood units requested by their physicians before surgery, and donors are more frequently unsuccessful as more units are requested. Therefore, 368 autologous blood donors who were requested to donate 4 or more units during the 6-week period before surgery at one community blood center were studied. More men were able to donate 4 units with no deferrals for anemia than were women (86% [181 of 211] compared to 42% [48 of 115], P less than 0.001). Greater success also was observed among donors with an initial hemoglobin level greater than 125 g/L (12.5 g/dL), those with higher weight, and those with more advanced age. Multiple logistic regression analysis showed that only higher initial hemoglobin levels (odds ratio, 3.3 per 10 g/L [1 g/dL] increment) and male sex (odds ratio, 2.7) were independent predictors of successful donation of 4 or more units.     

体外循环中的肝素涂层技术

肝素涂层技术是改进医疗设备血液、生物相容性的一种方法 ,首先应用于体外循环设备中。目前在美国及欧洲一些国家已经广泛应用于临床 ,取得了良好效果。本文针对肝素涂层技术的原理、实验研究、临床应用以及商品化设备等方面做一综述 ,并展望了肝素涂层技术的应用前景     

Evaluation of a non-invasive hemoglobin measurement device for pre-deposited autologous blood donation

A non-invasive hemoglobin measurement instrument (Sysmex Co.Ltd., Kobe, Japan) was used for the evaluation of hemoglobin levels just before blood drawing for repeat autologous blood donation. There was a statistically significant correlation (r = 0.598) between the hemoglobin levels determined with the non-invasive instrument (NINV-Hb) and true Hb levels (T-Hb) evaluated by direct analysis with automatic hematology analyzer, KX-21 (Sysmex). The analysis used 156 data obtained from 66 patients. Ten patients whose differences between NINV-Hb and T-Hb of the first blood donation were more than 2.1 g/dl were excluded from further analysis. Imaging analysis indicated difficulties with the detection of appropriate blood vessel images in one of these patients, but the reasons for other patients were not apparent. There was a closer relationship between NINV-Hb and T-Hb for the 76 measurements for the second or third blood donation obtained from 56 patients (r = 0.704) than for the entire data (r = 0.598). When 12 g/dl was used as the cut off value for NINV-Hb, sensitivity and specificity for the detection of 1l g/dl of T-Hb, which is considered the critical level for drawing autologous blood for donation, were 83.6% and 77.8%, respectively. We conclude, therefore, that NINV-Hb evaluation can be expected to be useful for repeated autologous blood donation of limited patients, however, it is strongly expected to develop a new system having more sensitive and accurately detectable ability.     

微型膜式氧合器在大鼠体外循环中的应用

目的建立大鼠体外循环（cardiopulmonary bypass，CPB动物模型）。方法选用雄性SD大鼠，经右颈静脉、股静脉插管引流，股动脉插管灌注建立CPB。CPB使用微型膜式氧合器，运转1h，期间监测血流动力学指标、心电图、血气及电解质的变化。结果8只大鼠CPB中血流动力学稳定，血气结果满意，完全符合满意CPB标准，停机后心血管和呼吸功能恢复。结论利用微型动物膜式氧合器建立的大鼠CPB模型，具有安全、稳定、简单、实用的特点，是进行与CPB相关脏器损伤研究可靠的实验平台。     

Comparative study of the protective effect using hypothermic cardiopulmonary bypass and normothermic cardiopulmonary bypass

Objective To explore the detrimental influence of normothermic and hypothermic cardiopulmonary bypass during open-heart surgery on immunity function,cytokines and complements.Methods Forty patients with congenital or rheumatic heart disease were randomized to receive the two strategies:normothermic CPB(study group)and hypothermic CPB(control group),20 cases in each group.Venous blood samples were collected at each time points of preoperation,end of CPB,day 1,4,7,14 postoperatively to examine the plasma level of IL-2,TNF-α,C3,C4,IgG,IgM,IgA,CD3,CD4,CD8.Results IL-2 in both groups decreased significantly at day 1,4,and returned to normal at day 7 postoperatively.IL-2 in control group was significantly lower than that in study group postoperatively.TNF-α in two groups was all higher at time points of end of CPB,day 1,4 postoperatively;in study group,it returned to normal level at day 7 postoperatively,whereas in control group,it was still higher at day 7 postoperatively than that before operation,and returned to normal at day 14 postoperatively.C3 in study group was significantly lower at time points of end of CPB,day 1,7 postoperatively than that in control group;C3 in both groups was all higher at time points of end of CPB,day 1,4 postoperatively;in study group,it returned to normal level at day 7 postoperatively,whereas in control group,it was still higher at day 7 postoperatively than that before operation and returned to normal at day 14 postoperatively.C4 in study group at time points of end of CPB,day 1 postoperatively was significantly lower than that in control group;C4 in both groups was all lower at time points of end of CPB,day 1,4 postoperatively than that before operation.The results showed that IgA after operation in both groups was significantly lower than that before operation,and returned to normal at day 7 postoperatively;IgA in study group at day 1 postoperatively was higher than that in control group.IgG in both group at time points of end of CPB,day 1,4 postoperatively was significantly lower than that before operation.IgG in control group was significantly higher at time points of end of CPB,day 1,4 postoperatively was significantly higher than that in control group.IgM in study group was significantly lower at time points of end of CPB,day 1,4 postoperatively.In control group,IgM was significantly lower at time points of end of CPB,day 1,4,7 postoperatively and returned to normal at day 14 postoperatively.IgM in study group was significantly higher at day 1,4 postoperatively than that in control group.CD3,CD4 in both groups decreased significantly at time points of end of CPB,day 1,4,and CD3、CD4 in study group and CD3 in control group returned to normal at day 7 postoperatively,CD4 in control group still lower than that before operation at day 7 postoperatively,and returned to normal at day 14 postoperatively.CD3,CD4 in control group was significantly lower at time points of end of CPB,day 1,4 than that in study group.CD8 in both groups increased significantly at day 1 postoperatively;there was no significant difference between the two groups.Conclusions The detrimental influence of open-heart surgery under normothermic CPB on humoral and cellular immunity function,cytokines and complements is less than that under hypothermic CPB,so normothermic CPB is beneficial for the postoperative recovery and anti-inflammation function.     

Preoperative coagulation studies to predict blood component usage in coronary artery bypass graft surgery

Bleeding remains a serious complication of cardiac surgery. Studies indicate that preoperative fibrinogen concentration is an independent predictor of blood loss during coronary artery bypass graft (CABG) surgery. This study evaluates whether fibrinogen concentration is a better predictor of blood usage than the prothrombin time (PT) and activated partial thromboplastin time (aPTT) tests. Patients not taking clopidogrel bisulfate who underwent CABG surgery during a 3-month period at a 350-bed community hospital were included in this prospective study. The parameters evaluated included patient’s age, preoperative coagulation test results (PT, international normalized ratio [INR], aPTT, fibrinogen), and number of blood components transfused. A probability value of less than 0.05 was deemed significant. Thirty-five patients were included in this study. Mean blood usage was 6 units. Patient’s age approached significance as a predictor of blood usage, and fibrinogen levels trended toward significance more than the other coagulation parameters. In this study, the increased age of the patient and low plasma concentrations of fibrinogen were associated with increased blood usage. Although no indicators clearly demonstrated statistical significance, the vast difference in the probability values for patients’ ages and fibrinogen levels indicated that there was a trend toward significance in blood usage for CABG patients. Further studies with larger patient populations are indicated.     

"All in one" cardiopulmonary bypass circuit for aortic surgery

We devised an "all in one" cardiopulmonary bypass circuit for aortic surgery, and evaluated its efficacy and safety. The circuit consisted of a venous line, reservoir, single centrifugal pump, membrane oxygenator and arterial line bifurcated into two lines for systemic perfusion and selective branch perfusion. The perfusion volume was regulated by an occluder and measured by a flow sensor. A closed partial bypass was established using a shunt line bypassing the reservoir. We applied this circuit to 25 patients with aortic disease. Regulation of both the selective cerebral perfusion (SCP) and the selective branch perfusion was easily performed. There was neither stroke nor organ dysfunction postoperatively. There are some cases in which it is difficult to decide the necessity for SCP preoperatively; the use of this circuit may resolve this problem. This circuit can be easily and safely applied to any type of aortic surgery.