Influence of different autotransfusion devices on the quality of salvaged blood.

BACKGROUND: Cardiopulmonary bypass causes a systemic inflammatory response and impaired hemostasis. We investigated whether intraoperative blood salvage with the cardiotomy suction contributes to these alterations. Furthermore, an alternative autotransfusion device (Haemonetics cell-saving device) was examined. METHODS: In 10 patients, interleukin-6, interleukin-8, tumor necrosis factor-alpha, thrombin-antithrombin complex, plasmin-antiplasmin complex, free hemoglobin, and the percentage of CD62+ thrombocytes were determined in the systemic circulation during cardiopulmonary bypass, in the cardiotomy suction tube, and in the blood from the cell-saving device. Additionally, bacterial contamination was examined. RESULTS: Median levels of interleukin-6 (52 versus 10 microg/L; p = 0.005), interleukin-8 (26 versus 20 microg/L; p = 0.017), tumor necrosis factor-alpha (24 versus 1 microg/L; p = 0.005), thrombin-antithrombin complex (113 versus 43 microg/L; p = 0.005), plasmin-antiplasmin complex (566 versus 489 microg/L; p = 0.022), and free hemoglobin (61 versus 30 mg/dL; p = 0.005) were higher in the cardiotomy suction tube compared with the systemic circulation. After processing the blood from the cell-saving device, interleukin-8, thrombin-antithrombin complex, and free hemoglobin remained above reference range, and in 90% of the cases bacterial contamination was observed. CONCLUSIONS: Cardiotomy suction additionally contributes to the release of proinflammatory cytokines, activation of coagulation, and hemolysis. Because blood salvage with a Haemonetics cell-saving device led to normalization of some, but not all, parameters and bacterial contamination was common, the alternative use seems at least questionable.     

Effect of autotransfusion on fibrinolysis in open heart patients

Autotransfused blood is often used as an alternative to banked blood. The fibrinolytic consequences of autotransfused blood are undefined. This prospective study was designed to determine the effect of intraoperative autotransfused blood on fibrinolysis and other coagulation parameters. Ten consecutive patients undergoing cardiopulmonary bypass (CPB) for open-heart procedures were studied. All patients received autotransfused blood intraoperatively and tolerated the procedure. Blood samples were taken preoperatively, intraoperatively, and at 6, 12, and 24 hours postoperatively. Coagulation parameters including prothrombin time (PT), partial thromboplastin time (PTT), fibrinogen, fibrin degradation products, and D-dimer levels were measured at each time point. In addition, the quantity of autotransfused blood and additional standard blood products were recorded. Nonparametric repeated measures analyses with post hoc tests adjusted using the Bonferroni correction were used to analyze the data. Mean PT increased from 13.9 +/- 3.0 seconds preoperatively to 15.7 +/- 1.6 seconds intraoperatively, but then gradually declined to 14.5 +/- 1.1 seconds 24 hours postoperatively. A similar temporal pattern was observed for PTT, which reached a peak of 55.7 +/- 33.0 seconds intraoperatively from a preoperative baseline of 44.0 +/- 15.3 seconds. Adjusted post hoc comparisons of fibrinogen levels indicated a statistically significant difference between preoperative and 6 hour postoperative medians, (p < .0083). Fibrin degradation products had a modest and nonsignificant decrease over the 24-hour study period, (from 12.6 +/- 6.7 mcg/mL preoperatively to 9.0 +/- 1.6 mcg/ml 24 hours postoperatively), while D-dimer levels rose from a baseline of 0.54 +/- 0.09 mcg/mL to 0.98 +/- 0.48 mcg/mL 6 hours postoperatively, but declined nearly to baseline by 24 hours postoperatively, (0.62 +/- 0.11 mcg/mL). We conclude that although autotransfused blood may activate the fibrinolytic pathway, its use remains safe and does not require the use of additional banked blood products.     

Experimental substantiation of the sorption of reinfused blood

An analysis of results of experiments on the assessment of morphofunctional properties of the bacterio-contaminated blood has been made. A conclusion is drawn that it is expedient to use hemosorption in order to provide safe reinfusion in patients with massive blood loss and injury of hollow organs of the abdomen.     

自体血回输对病人血浆肝素含量的影响

目的　观察自体血回输对病人血浆中肝素含量的影响 ,探讨肝素在血液回收时的应用。方法　自体血液回输组 (n =32 )与异体输血组 (n =30 )骨科、脑科择期手术病人 ,男女各半 ,年龄 18～ 48岁 ,术前肝、肾、凝血功能均正常 ,无其他血液系统疾病。自体回输血量及异体输血量均超过 10 0 0ml。采用凝固法测定血浆中肝素含量 ;ACT Ⅱ型测定仪测定血中活化凝血时间 (ACT)。结果肝素含量 :自体血液回输组 ,术前、输血前、输血后 2小时肝素含量分别为 (0 6 5± 0 2 7)、(0 6 8±0 2 0 )和 (0 72± 0 19)U/ml;异体输血组分别为 (0 6 3± 0 2 4)、(0 6 7± 0 2 8)和 (0 6 9± 0 2 0 )U/ml。两组间均无显著差异 (P >0 0 5 )。ACT :自体血回输组三个不同时间分别为 (86 10± 2 0 5 4)、(133 5 0± 2 9 6 5 )和 (95 0 5± 2 9 71)秒 ;异体输血组分别为 (88 42± 18 37)、(131 70± 2 7 36 )和(92 86± 14 35 )秒。两组ACT值输血前均明显长于术前 (P <0 0 5 ) ,术前与输血后 2小时无显著差异 (P >0 0 5 )。结论　自体血液回输组与异体输血组术前、输血前、输血后 2小时肝素含量无显著差异。自体血回输中使用肝素抗凝适量 ,安全可行     

Effect of the autotransfusion of UV-irradiated blood on the homeostatic indices of surgical patients

The investigation of parameters of hemograms, biochemical composition of blood, hemostasis, certain indicators of the immunological status in transfusing UV-irradiated autologous blood the authors made a conclusion that this variant of autohemotransfusion exerted a specific effect on the patient's organism. It depended on the scheme of irradiation of the blood, number of sessions of autotransfusions and intervals between them.     

冠状动脉旁路移植术中自体血液回收对红细胞的影响

目的观察经国产自体-3000型血液回收机(北京京精医疗设备公司)回收处理的红细胞变形性、小变形性、取向性和在体内半衰期的改变. 方法连续在非体外循环下行冠状动脉旁路移植术患者20例,根据术中是否进行自体血液回收分为两组,实验组(n=10):术中行血液回收;对照组(n=10):术中不行血液回收.对实验组经自体血液回收处理的红细胞和对照组未经回收处理的红细胞分别采用激光衍射法测定红细胞变形指数(DI),最大取向指数[(DI)or.max],最大小变形指数[(DI)d.max]和采用同位素51Cr标记法测量红细胞在体内的半衰期(51C1/2). 结果实验组经血液回收处理的红细胞DI,(DI)or.max,(DI)d.max和51C1/2与对照组比较差别无显著性意义(P>0.05). 结论在心脏不停跳冠状动脉旁路移植术中,国产自体-3000型血液回收机对回收处理后的红细胞变形性、小变形性、取向性以及在体内的半衰期没有明显的影响.     

Effects of autotransfusion on blood elements

The effects of autotransfusion on cellular and other components of autologous blood were studied in forty adult dogs. An increase in free plasma hemoglobin and a decrease in hematocrit, red blood cells, and white blood cells were seen immediately after autotransfusion with canine blood exposed to the peritoneal cavity (group II) and blood collected in a siliconized beaker (group I). After autotransfusion, a significant decrease in platelets and a significantly higher free plasma hemoglobin level were noted in dogs in group II. In the five day period after autotransfusion the white blood cell and fibrinogen levels remained elevated whereas free plasma hemoglobin, hematocrit, red blood cell, and platelet levels returned to near normal. Prothrombin time, thrombin time, and partial thromboplastin time were within normal limits throughout the experimental period. Red blood cell survival after autotransfusion was found to be normal relative to controls. Screen filtration pressure was markedly elevated in blood suctioned from the abdominal cavity. Filtration with the autotransfusion reservoir filter resulted in a decrease in screen filtration pressure to a measurable but elevated level whereas screen filtration pressure returned to normal after Dacron wool filtration. No alteration in lipoproteins or elevation of plasma lipids was found with prolonged autotransfusion and no fat emboli were observed histologically. All dogs survived and showed no evidence of bleeding, thrombosis, or insult to pulmonary or other organ system function.     

自体血液回收对全髋关节置换术患者炎性因子的影响

目的:观察自体血液回收对骨科手术患者炎性因子的影响。方法:40例择期行全髋关节置换手术患者,ASA分级Ⅱ级,采用随机数字表法分为两组:自体血液回收组(A组)和异体输血组(B组),每组20例。回收组术中应用血细胞回输仪进行血液收集、回输,两组均于输血前(T1)、输血后1h(T2)、4h(T3)、8h(T4)四个时点测定血浆TNF-α、IL-6、IL-10浓度。记录患者术中回收血量,异体浓缩红细胞量及血浆用量。结果:手术开始至术后24h内回收组输注异体浓缩红细胞量及血浆用量较对照组明显减(P<0.05);两组患者输血后TNF-α、IL-6、IL-10较输血前显著均增高(P<0.05),与A组比较,B组TNF-α、IL-6在输血后各时点显著增高,而IL-10则明显降低(P<0.05)。结论:全髋置换术中使用自体血回收技术,可明显减轻的TNF-α、IL-6、IL-10等炎性因子表达程度的改变。     

Intraoperative autotransfusion in cardiac operations. Effect on intraoperative and postoperative transfusion requirements

The Southern Arizona Regional Red Cross Blood Program, in cooperation with two cardiac surgery groups, examined the effect of intraoperative autotransfusion on red cell, plasma, and platelet usage during and after cardiac operations. The study evaluated whether intraoperative autotransfusion influenced intraoperative or postoperative blood usage and whether regular use was more effective than selective use. The study demonstrated that intraoperative autotransfusion reduces intraoperative and postoperative blood use and that regular use of intraoperative autotransfusion is more effective than selective use.     

人工关节置换术后伤口引流血自体回输的作用

[目的]评估人工关节置换术后伤口引流血自体回输的有效性及安全性。[方法]选取2009年2～5月间于本科行人工髋、膝关节置换术的30例患者作为研究对象,应用ContavacTMCBCⅡ自体血液回输器回输术后6h内伤口引流血,根据患者异体输血量、血红蛋白水平变化以及伤口引流血中红细胞形态评价引流血自体回输的有效性;根据患者有无发热、溶血反应、凝血功能障碍、肺栓塞、脂肪栓塞、全身感染等以评估引流血自体回输的安全性。[结果]平均每例患者伤口总出血量为(946±433)ml,自体血回输(622±313)ml,异体输血(233±348)ml;伤口引流血中红细胞形态完整,血红蛋白含量为99.67g/L,术后第1d较术后即刻血红蛋白显著降低。1例患者出现异常发热,无患者发生其他并发症。[结论]人工关节置换术后6h内的伤口引流血为有效血液成分,回输后能够减缓血色素下降速度,节省术后异体血用量,是一种安全、有效补充血液成分的方法。     

Effect of breathing pattern on the pressure-time product calculation

Background:  The pressure-time product (PTP) is often used to compare conditions with different breathing patterns. Being the pressure-time product calculated with pressures changes over a minute, mechanical load and inspiration time per minute should be its main determinants. The aim of this study was to investigate if the method of PTP computation is affected by the breathing pattern when mechanical load and inspiratory time per minute are constant.
Methods:  Respiratory mechanics and the PTP developed by the ventilator were calculated in 10 mechanically ventilated patients at three different respiratory rate/tidal volume combinations, provided that minute ventilation and inspiratory time per minute were constant.
Results:  The static elastance did not change at different tidal volumes. Despite the constant elastic load over a minute, the elastic PTP showed an increment greater than 200% from the higher to the lower respiratory rate, responsible for approximately 80% of the whole PTP increment. On the contrary a 'corrected' elastic PTP (calculated using the square root of the elastic pressure-time area), the elastic double product of the respiratory system and the mean elastic pressure per minute, did not significantly change.
Conclusions:  Changes in breathing pattern markedly affected the PTP independently by the mechanical load and the inspiratory time per minute. In these conditions it could not correctly estimate the metabolic cost of breathing. The use of a 'corrected' PTP, the mean inspiratory pressure per minute or the double product of the respiratory system, could overcome this limitation.     

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。     

自体输血在骨科手术中的应用

我院自1999年3月开展自体血回输技术,明显减少了异体输血用量,未出现明显不良反应,现报告如下. 1 临床资料 本组275例,男176例,女99例;年龄17～82岁,平均68岁.     

The effect of intraoperative autotransfusion on the oxygen affinity of erythrocytes

Intraoperative autotransfusion provides several advantages over homologous transfusion for the recipient. Since the harvested red cells have a normal 2,3-DPG concentration [15, 18], the decreased oxygen affinity of hemoglobin [26] that occurs in the recipient after the transfusion of stored blood is thought to be avoidable by intraoperative autotransfusion. In a study on the influence of harvested cells on oxygen affinity in patients by Orr and Blenko [18], however, it was not possible to demonstrate the superiority of these erythrocytes over stored red cells in the recipient: whereas 2,3-DPG remained at the preoperative level in both groups after transfusion, oxygen affinity increased postoperatively in the study group but not in the control group. In this study we directly determined oxygen affinity in addition to 2,3-DPG in the harvested cells after processing. The influence on the recipients' oxygen affinity after transfusion was analyzed and compared to that of a group of patients who received only stored blood. PATIENTS and METHODS: Three groups of patients were studied: Group 1 received only autotransfusion blood, group 2 autotransfusion and stored blood, and group 3 only stored blood. For harvesting, centrifugation, and washing of the red cells the Haemonetics Cell Saver (CS III) was used. The p50 value - which is generally accepted as a measurement of oxygen affinity - was determined as described by Müller-Plathe and Müller-Plathe [17]. For analysis of these data, blood was drawn from patients pre- and postoperatively and for the majority of cases also one or more days postoperatively.(ABSTRACT TRUNCATED AT 250 WORDS)