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.     

Rh(D)阴性血型病人剖宫产术中成分式自体输血的安全性

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.     

Rh(D)阴性血型病人剖宫产术中成分式自体输血的安全性

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.     

外科手术患者安全感的调查分析

目的了解外科手术患者的总体安全感水平。方法采用便利抽样的方法抽取山东省6所综合医院的243例外科手术患者,采用自行设计的外科手术患者安全感问卷对其进行调查。结果外科手术患者安全感得分为89.07±15.08;安全感各维度得分由低至高依次为人际关系2.92±0.60,疾病病情3.43±1.07,医院环境3.56±0.99,医护行为4.45±0.59,医院管理4.54±0.59。得分最低的条目是"我希望得到与医护人员交流的机会",得分最高的条目是"我对护士的服务态度感到满意"。结论外科手术患者的安全感为比较安全水平,人际关系方面的安全感最低。医护人员在注重疾病治疗护理的同时,需更清楚地了解患者的感受和需求,加强与患者的沟通交流,以提高其安全感。     

输血安全和临床输血概论(1)

输血最初只是将献血者的血液输给病人．特别是发生严重失血的病人，以达到缓解其症状、保证其机体各组织器官血液供应的治疗目的。现在输血已发展成一门独立的临床医学学科——输血学。输血学围绕将献血者血液输给病人进行救治这一中心，研究、开发和应用一切可采用的科学和技术手段及管理措施，提高供病人输注的血液和血液制品(包括血液代用品和人造血液)的质量和安全性，从而保证临床输血的安全性和治疗效果。     

临床颈淋巴结阴性的甲状腺癌181例治疗分析

通过对临床颈淋巴结阴性的甲状腺癌治疗结果分析,提出采用甲状腺腺叶加峡部切除加中央区颈淋巴清扫术的治疗方法可获长期治愈的结果。方法:回顾分析1985年1月至2000年6月181例临床颈淋巴结阴性的甲状腺癌采用上法治疗的结果。结果:181例病人中仅12例(6.6%)补充作了同侧的颈淋巴结清扫术;12例行颈清扫术者中有10例见淋巴结转移。结论:对临床颈淋巴结阴性的甲状腺癌可以采用甲状腺腺叶加峡部切除加中央区淋巴结清扫术,其长期疗效同传统的甲状腺癌联合根治术,但生活质量却大为提高,值得临床推广。     

加强血液质量管理以确保临床用血安全

血站是采集和提供临床用血的机构,以提供安全有效的血液为职责,保证血液的安全有效是血站全面质量管理的最终目标,也是输血工作者奋斗的目标。血液质量管理从采集、分离、检测、贮存、运输直至输注的整个过程,其中任何一个环节出现差错,都可能给受血者造成非常严重的、甚至致命     

直肠癌误诊41例临床分析

直肠癌是常见结直肠癌之一，其近年来发病率和死亡率呈逐年上升趋势。外科治疗迄今仍是其主要的治疗手段，由于种种原因，临床上误诊而延误治疗者仍屡见不鲜，使不少能手术根治患者失去治疗良机。我院于2000年1月至2002年6月共收治直肠癌患者169例，其中首诊误诊41例，占24．2％，本文结合临床资料对其误诊的原因进行分析。     

血管外科患者住院期间护理安全问题分析及应对

通过对血管外科患者在住院期间可能存在的安全问题进行回顾性分析和讨论,对护理人员进行安全意识和专业技术培训,从而使血管外科护理人员认识到住院患者安全问题管理的重要性。对患者实施人文关怀,根据不同患者的具体情况给予针对性的护理措施,同时加强和改进安全管理对策,将不安全因素降到最低,最大限度地减少对患者的伤害,避免不良事件的发生。     

胃癌并发穿孔患者的外科手术治疗临床分析

目的对胃癌并发穿孔的临床诊断和外科手术治疗的效果进行分析评价。方法对26例胃癌合并穿孔患者的临床资料、病理特点和手术方式进行回顾性分析。结果 26例患者中12例行穿孔修补术(其中5例患者在行穿孔修补术后20 d左右,行二期手术姑息性切除或根治性切除),11例行姑息性切除术,3例行根治性切除术。围手术期死亡3例,死亡原因为感染性休克致多脏器功能衰竭和穿孔修补处再穿孔。结论胃癌并发穿孔患者多数病情危重且复杂,早期诊断和积极的手术治疗,选择正确合理的手术方式对降低胃癌穿孔患者病死率、改善其预后有重要意义。     

反对：高危患者在血管外科手术前应行冠状动脉重建术

临床麻醉医师常常面对高危非心脏手术患者手术前危险分级的困难。总的来说，实施择期手术、患一般内科疾病而无心脏症状的患者围手术期发生心脏并发症的风险极低；因此，可能不需要特殊的辅助检查。然而正如Kenai的综述中所讨论到的，接受血管外科手术的患者常患有动脉粥样硬化性心脏病，当涉及到主动脉和动脉手术操作时会出现复杂的血液动力学变化，手术前需要特别注意。冠状动脉疾病是所有血管外科手术术后死亡的主要原因，因此手术前考虑行冠状动脉重建术无可厚非。     

肾包虫病的诊断和外科手术治疗(附15例临床分析)

目的：探讨肾包虫病的诊断和治疗。方法：对手术治疗的肾包虫病15例临床资料进行回顾性分析。结果：15例均生活在包虫流行区，患侧肾区隐痛，腹部包块为主要临床表现，均经手术摘除肾包虫囊而治愈。结论：B超，CT检查是诊断肾包虫病的主要方法。肾脏包虫内囊摘除并外囊残腔壁切除，消灭残腔是首选治疗方法。     

神经外科老年患者的临床观察与护理

随着人口老龄化，本院老年神经外科疾病发病数呈逐年上升趋势（见表1）。老年患者由于其生理性老化，抗病能力降低，重要器官代偿能力减弱外，还常有呼吸、循环、内分泌、消化等多系统疾病并存，在临床表现和护理上有其自身特点。本文对2006年1月至2006年12月收治的522例老年神经外科住院患者的临床护理进行回顾性总结，介绍如下。     

提高高原地区断指(肢)成活的临床分析

近年来西藏高原地区先后取得断腕、断指再植成功[1]，但其成活率明显低于内地。我院地处海拔3，658米的拉萨市，多年来因手术条件差，且在低氧环境下，对此类急诊病人多采取消极截指手术。随着高压氧舱的建立，我们尝试进行了再植手术，取得可喜进步。从1997年5月～2002年4月共收治断指（肢）病人17例，成活7例，现报道如下。１资料与方法１．１一般资料本组病人男13例，女4例，年龄16～45岁，平均28.5岁。断指缺血时间6h以内11例，6h以上6例。损伤类型：切割伤12例，绞挫伤5例；损伤平面：断腕3例，踝关节不全离断1例，13例病人21指完全离…     

老年肺癌患者外科治疗临床分析(附56例报告)

目的探讨老年肺癌患者外科治疗的近期临床效果。方法对2010-01—2015-01收治的56例老年肺癌患者实施外科手术治疗。回顾性分析患者的临床资料。结果术后16例(28.57%)患者出现并发症,其中心律失常4例,呼吸功能衰竭5例,肺内感染3例,心力衰竭3例,肺不张1例。经治疗后,2例(3.57%患者)因呼吸衰竭死亡。其余54例患者均安全度过围手术期。结论高龄并非是老年患者实行外科手术治疗的绝对禁忌证,严格掌握手术适应证,选择合理的手术治疗方式,做好围手术期管理,可有效提高手术效果,降低患者病死率,改善其生存质量。     

老年肺癌患者外科治疗临床分析(附56例报告)

目的探讨老年肺癌患者外科治疗的近期临床效果。方法对2010-01—2015-01收治的56例老年肺癌患者实施外科手术治疗。回顾性分析患者的临床资料。结果术后16例(28.57%)患者出现并发症,其中心律失常4例,呼吸功能衰竭5例,肺内感染3例,心力衰竭3例,肺不张1例。经治疗后,2例(3.57%)患者因呼吸衰竭死亡。其余54例患者均安全度过围手术期。结论高龄并非是老年患者实行外科手术治疗的绝对禁忌证,严格掌握手术适应证,选择合理手术治疗方式,做好围手术期的管理,可有效提高手术效果,降低患者病死率,改善其生存质量。     

334例血液净化治疗中毒患者的临床分析

血液净化是毒物中毒治疗的一个重要方法,毒物的种类不同,治疗效果差异很大.近年来随着社会生活的变迁,中毒毒物种类发生很大变化,血液净化技术在毒物中毒急救方面也发生了明显的变化,为了了解这种变化,本文对2002年~2011年期间中毒在我院接受血液净化治疗的中毒患者资料进行回顾性分析,现报道如下.     

近、远端胃癌临床病理特点分析(附428例报告)

目的：进一步探讨近，远端胃癌的临床病理特点，方法：收集和分析了118例近端胃癌（PGC）的临床和病理资料，并与同期310例远端胃癌（DGC）患者的相关资料进行比较。结果：近端胃癌的发生率较低，临床分期多数为Ⅲ期和Ⅳ期，病理组织学类型以低分化，未分化及粘液腺癌为多，手术类型中全胃切除术及联合脏器切除术占较高比例，断端癌残留及淋巴结转移率显著增高，伴有食管受累的患者其淋巴结转移的阳性大大增加。随访5年生存率，PGC组显著低于DGC组，手术后并发症及手术死亡率两组间的差异无显著性意义。结论：临床晚期癌多，食管容易受累及病理组织学分化差是近端胃癌预后差的重要原因，早期诊治是提高疗效的关键。     

110例老年患者麻醉问题临床分析

目的探讨老年患者麻醉过程中发生的临床问题及应对措施。方法对110例实施麻醉的老年患者,在麻醉过程中所发生的问题进行临床分析。结果经过积极的麻醉前准备和麻醉过程中对高血压、心律失常、低血氧等问题的正确处理,无1例患者因麻醉用药不当或是麻醉方法选择错误而发生并发症。结论老年人由于全身器官功能减退,免疫及抵抗力下降,存在一定风险性。合理选择麻醉方法与麻醉药的用量,密切监测麻醉中的各项指标,及时发现并处理问题,可避免麻醉并发症的发生。     

手术治疗胫骨平台骨折(附48例临床分析)

<正> 胫骨平台骨折是一种常见损伤,常见于轻微创伤后的老年人及遭受高能损伤的中青年人。属膝关节内骨折,处理比较困难。自1992年至2000年我院共手术治疗胫骨平台骨折48例,现报告如下。 1 临床资料 1.1 一般资料:本组病人38例,男35例,女13例。年龄19岁～72岁,平均38.4岁。根据Hohl分型法分型:Ⅰ型9例,Ⅱ型13例,Ⅲ型8例,Ⅳ型6例,Ⅴ型7例,Ⅵ型5例。合并颅脑损伤10例,胸腹脏器伤5例。左侧20例,右侧28例。 1.2 治疗方法:Ⅰ～Ⅱ型骨折采用切开复位松质骨螺丝