负压在自体血回收中对红细胞压积与回收血量的影响

目的 探讨术中自体血回收时不同负压对红细胞压积(Hct)及回收血量的影响.方法 采用不同负压在术中收集血液,比较不同负压下收集的原血Hct和回收血量的情况.结果 负压为150 mm Hg时收集的血液红细胞破坏较少且基本能满足手术中收集血液的需要,而负压超过250 mm Hg时红细胞大量破坏,回收血量大大降低.结论 使用恰当的负压是术中自体血回收质量的重要保证.     

术中自体血液回收121例的临床观察

目的 为了解决血源紧张以及减少输血并发症，应用Medtronic autoLog^TM血液回收机共对121例患者进行术中自体血液回收并观察其效果。方法 选择择期预计出血量〉600ml，无自体血液回收禁忌证和急诊大出血患者121例，术时接好血液回收机，在术中或手术结束时将浓缩红细胞回输给患者。结果 （1）98．4％的患者术后Hb及Hct测定趋于正常，WBC与术前比较差别有显著性。（2）77．8％的患者术中不用再输库血，121例患者总共回收浓缩血量达56222ml，自体血回收率为40．2％。结论 应用自体血液回收机进行术中自体输血安全有效。     

术中自体血液回收与回输的应用研究

目的探讨自体血液回收技术在血液保护中的作用。方法运用ZITI-2000型血液回收机回收与回输自体血116例,监测术前及术中心率（HR）、平均动脉压（MAP）、动脉血氧饱和度（SpO2）、血红蛋白（Hb）、血细胞比容（Hct）、血小板计数（PLT）的变化,测定红细胞悬液的Hct,记录每例回收血量、回输血量和异体输血率。结果①平均每例回收血3379m l,回输血液1235m l,异体输血率为25.8%。②回输后HR、MAP、SpO2、Hb、Hct显著上升（P〈0.01）,PLT无显著变化。③回输红细胞悬液Hct为0.41～0.49。结论自体血液回收技术是一种安全、可靠的血液保护技术,可显著节约血源和减少异体输血。     

国产血液回收机在骨科大手术中自体血回收效果研究

目的评价国产型血液回收治疗仪在骨科手术中自体血液的回收效果。方法 60名骨科手术患者,根据血液回收设备的不同,随机分为2组:国产组(北京型)和进口组(美国型),每组30例。检测比较2组回输血液的Hb、Hct、WBC、Plt、p H、Na+、K+、Ca2+、乳酸(Lac)含量,记录回收血量和回输血量,比较红细胞回收率。结果国产组与进口组比较,2组回输血液的Hct均在50%(P0.05);其余各项检测指标(P0.05);2组红细胞回收率无统计学意义(P0.05),均在95%。结论国产型血液回收治疗仪在骨科手术中自体血回收效果与进口型相当。     

回收式自体输血在骨科手术中的应用

目的探讨回收式自体输血在骨科手术中的应用.方法将骨科较大手术35例随机分为两组:实验组(术中采用回收式自体输血)与对照组.比较两组病人手术前、后血红蛋白(Hb)、红细胞压积(Hct)以及术中出血量、输异体血量及比例.结果两组病人手术前、后Hb、Hct值及术中出血量相似,而输入异体血量及比例有非常显著性差异(P＜0.01).结论回收式自体输血可减少或避免输异体血,减少甚至杜绝输异体血相关并发症.     

自体血液回收在心血管外科手术中的应用

目的：探讨心血管外科手术中自体血液回收技术对于异体血用量的影响。方法：将46例心血管外科手术患者,按是否使用术中自体血液回收技术随机分为两组,观察组采用术中自体血液回收技术;对照组没有使用术中自体血液回收,分别统计两组术中或术后输异体血量、检测术后24小时血常规变化;观察组需统计自体血液回收量和回输量。结果：观察组的输异体血量明显低于对照组（P〈0．05）。所有患者术后24小时血常规较术前均有明显差异（P〈0．05）,术后Hb、Hct、Plt比术前明显降低;比较两组术后24小时血常规无显著差异（P〉0．05）。结论：自体血液回收技术应用于心血管外科出血量较大的手术,能明显减少异体血用量,减少输异体血所引起的各种并发症,值得在其它科手术中推广应用。     

双向负压卷曲式自体血回收袋在手术中的应用

目的：探讨自体血回收的新方法。方法：对48例手术病人用双向负压卷曲式回收袋回收自身体，观察其各项临床指标。结果：解决了传统自体血回收法造成的红细胞破坏问题，提高了单位体积内的红细胞计数，减少了血液可能被污染的环节。结论：保证了红细胞的质量及回收率，操作简单、安全。     

双向负压卷曲式自体血回收袋在手术中的应用

目的　探讨自体血回收的新方法。方法　对 48例手术病人用双向负压卷曲式回收袋回收自体血 ,观察其各项临床指标。结果　解决了传统自体血回收法造成的红细胞破坏问题 ,提高了单位体积内的红细胞计数 ,减少了血液可能被污染的环节。结论　保证了红细胞的质量及回收率 ,操作简单、安全。     

术中自体血液回收249例临床总结

目的 观察术中自体血液回收在各种手术中的应用。方法 应用COBE BRAT2自体血液回收机对249例行各种手术的病人进行自体血液回收,经过抗凝、回收、过滤、洗涤程序处理后再回输给病人,并记录每例病人的回收血量和回收血的血细胞比容。结果 249例病人术中每例回收浓缩红细胞悬液100～2700ml不等,平均每例回收520±347ml,共129566ml。经血液回收机处理后获得的血液,血细胞比容>37％的有174例,每例回收浓缩红细胞悬液150～2700ml不等,平均每例回收608±371ml,共105830ml。结论 术中自体血液回收是安全、有效的自体输血方式,节省了大量的库血,减少了输血并发症。     

自体血回收在脑膜瘤手术中的应用

目的：探讨回收式自体输血在脑膜瘤手术中的应用效果。方法：选择术前估计出血量大于800 ml的择期脑膜瘤手术患者20例,术中使用全自动自体血液回收机收集、抗凝、回收、洗涤、过滤程序处理后的红细胞悬液回输给患者。观察术中出血量、回输血量及输异体血量自体血回输过程患者的变化,术后血肿及感染情况。结果：脑膜瘤手术患者出血量（1 572±721.03）ml,洗涤红细胞悬液（840.59±407.46）ml,占出血量的50.5%。2例未输异体血,18例输异体红细胞、7例输新鲜血浆。术后除1例因出血量多而发生颅内血肿须紧急手术清除血肿外余均无血肿、切口感染发生。结论：自体血回收在脑膜瘤手术中,尤其是出血较多的巨大脑膜瘤手术,可以减少输注异体血量,缓解血源紧张、节约用血,还可预防过多输注异体血引起的不良反应及血源性传染病。     

A comparison of hemolysis and red cell mechanical fragility in blood collected with different cell salvage suction devices

BACKGROUND: Suction pressure is one variable that can affect the efficiency of red blood cell (RBC) recovery for intraoperative autotransfusion. This study compared a constant-suction-pressure system with a device that is expected to minimize hemolysis by automatically varying the suction pressure. STUDY DESIGN AND METHODS: Twenty-two 50-mL reconstituted whole-blood samples were collected from a flat surface with either a constant-pressure suction device (BRAT 2 autologous blood recovery system, COBE Cardiovascular) set to a pressure of -200 mmHg or a variable-pressure suction device (SmartSuction Harmony surgical suction pump, Haemonetics, Inc.). Time of blood collection was recorded and plasma free hemoglobin (PFHb) was spectroscopically measured in the aspirated blood. Postcollection blood was subjected to RBC mechanical fragility test to characterize potential sublethal blood trauma. Relative hemolysis and the mean fragility index (MFI) were calculated. RESULTS: Hemolysis was significantly reduced with the variable-pressure suction compared to the constant-pressure suction (2.17% vs. 3.20%, respectively; p < 0.001). There was no significant difference between both suction devices in either the MFI of RBCs (0.632 vs. 0.673, respectively; p > 0.05) or the collection time at -200 mmHg (54.2 seconds vs. 52.8 seconds, respectively; p > 0.05). CONCLUSIONS: Although the variable-pressure device produced a significant reduction in hemolysis during one-pass blood collection, the clinical significance of this reduction is not clear. In relative terms, the variable-pressure device would recover an extra 10 mL of RBCs for every liter of salvaged RBCs, which is negligible compared to the blood loss in major surgery.     

A cost study of postoperative cell salvage in the setting of elective primary hip and knee arthroplasty

BACKGROUND: The increasing costs, limited supply, and clinical risks associated with allogeneic blood transfusion have prompted investigation into autologous blood management strategies, such as postoperative red blood cell (RBC) salvage. This study provides a cost comparison of transfusing washed postoperatively salvaged RBCs using an orthopedic perioperative autotransfusion device (OrthoPat, Haemonetics Corporation) versus unwashed shed blood and banked allogeneic blood. STUDY DESIGN AND METHODS: Cell salvage data were retrospectively reviewed for a sample of 392 patients who underwent primary hip or knee arthroplasty. Mean unit costs were calculated for washed salvaged RBCs, equivalent units of unwashed shed blood, and therapeutically equivalent volumes of allogeneic RBCs. RESULTS: No initial capital investment was required for the establishment of the postoperative cell salvage program. For patients undergoing total knee arthroplasty (TKA), the mean unit costs for washed postoperatively salvaged cells, unwashed shed blood, and allogeneic banked blood were $758.80, $474.95, and $765.49, respectively. In patients undergoing total hip arthroplasty (THA), the mean unit costs for washed postoperatively salvaged cells, unwashed shed blood, and allogeneic banked blood were $1827.41, $1167.41, and $2609.44, respectively. CONCLUSION: This analysis suggests that transfusing washed postoperatively salvaged cells using the OrthoPat device is more costly than using unwashed shed blood in both THA and TKA. When compared to allogeneic transfusion, washed postoperatively salvaged cells carry a comparable cost in TKA, but potentially represent a significant savings in patients undergoing THA. Sensitivity analysis suggests that in the case of TKA, however, cost comparability exists within a narrow range of units collected and infused.     

Low-prime perfusion circuit and autologous priming in CABG surgery on a Jehovah's Witness: a case report

Cardiac surgery on Jehovah's Witnesses is a great challenge for the cardiothoracic surgery team and especially for the perfusionist. To reduce the risk of surgery in these patients, a very small extracorporeal circuit was designed to decrease the amount of priming volume and thereby the degree of hemodilution. A small bypass system was built, consisting of a 3/8-in. arterial line and a 3/8-in. venous line, a venous collapsible reservoir, a centrifugal pump, a hollow fiber oxygenator and a cell saver reservoir. The circuit priming volume was 650 ml. By using antegrade and retrograde autologous priming, the total amount of priming was reduced to +/-50 ml. Bypass time was 63 min with an average blood flow of 5300+/-114 ml/min and postmembrane pressures of 180+/-45 mmHg. Venous line pressure was monitored and kept between -8 and -20 mmHg with a mean arterial pressure (MAP) of 55+/-12.3 mmHg. The hematocrit before extracorporeal circulation (ECC) was 36%, per-ECC 35% and post-ECC 35%. On the fifth postoperative day, the hematocrit was 40%. The patient was discharged 7 days after surgery. A low-prime circuit, in combination with autologous priming, seems to be safe and effective in avoiding the use of banked blood.     

Blood pressure and hematocrit in diabetes and the role of endothelial responses in the variability of blood viscosity

OBJECTIVE: To investigate the relationship between mean arterial blood pressure and hematocrit in a population of treated diabetic patients and a control population of healthy individuals. RESEARCH DESIGN AND METHODS: Data on hematocrit and blood pressure were obtained from 129 diabetic subjects (87 women and 42 men) and 103 healthy subjects (76 women and 27 men) enrolled in a cross-sectional study. Alcohol consumption, ischemic heart disease, stroke, neoplasia, renal, hepatic, and chronic inflammatory disease were exclusion criteria. RESULTS: The hematocrit of diabetic patients ranged from 0.35 to 0.52, and blood pressure had a bimodal distribution described by a second-order polynomial (P < 0.001), whereby elevated pressures correlated with low and high hematocrit, while the minimum average pressure was at hematocrit 0.43. Hematocrit of normal control subjects (range 0.28-0.55) was uncorrelated to blood pressure (averaged 99.7 +/- 9.7 mmHg). High blood pressure, low hematocrit diabetic subjects up to the minimum average hematocrit of 0.43 had a negative correlation (P < 0.0001) between these variables. CONCLUSIONS: Our findings are compatible with the hypothesis that diabetic patients present normal responses to hematocrit variation and therefore blood viscosity and shear stress in mediating the release of vasodilators and lack the ability to autoregulate blood pressure relative to differences in hematocrit by comparison to nondiabetic subjects. These findings also suggest that the treatment of diabetes should target maintaining an optimal hematocrit in order to lower cardiovascular risk.     

术中自体血液回收对红细胞流变学的影响

目的通过检测术中自体回收血液的流变学指标,评价血液回收技术对红细胞流变学的影响。方法前瞻性自身对照研究,观察20例2018年1~12月于首都医科大学附属北京友谊医院择期行非停跳冠脉动脉旁路移植手术、拟使用术中自体血液回收机对术野血液进行回收的患者。采用椎板法对患者静脉血、术中自体回收血液和同期10份使用枸橼酸-磷酸-葡萄糖-腺苷保护液贮存10~15 d的悬浮红细胞进行聚集指数,变形指数和全血黏度检测。结果自体回收红细胞的聚集指数和变形指数分别为4. 37±0. 83和0. 84±0. 22,静脉血红细胞分别为4. 55±0. 83和1. 01±0. 25,两者相比较差异均无统计学意义(P=0. 413,0. 051);自体回收红细胞的切变率200/s、切变率30/s、切变率5/s和切变率1/s时的全血黏度分别为3. 40±0. 54 m Pa·s、4. 36±0. 84 m Pa·s、7. 12±1. 85 m Pa·s和15. 10±5. 15m Pa·s,静脉血红细胞分别为3. 15±0. 90 m Pa·s、4. 05±1. 18 m Pa·s、6. 67±2. 06 m Pa·s和14. 25±4. 80 m Pa·s,两者相比差异均无统计学意义(P=0. 234,0. 310,0. 428,0. 543)。贮存10~15 d的悬浮红细胞的聚集指数和变形指数分别为4. 55±1. 41和0. 91±0. 30,与静脉血红细胞相比差异无统计学意义(P=0. 892,0. 863);悬浮红细胞在切变率5/s和切变率1/s时全血黏度分别为6. 45±1. 29 m Pa·s和13. 79±3. 35 m Pa·s,与静脉血红细胞相比差异均无统计学意义(P=0. 103,0. 203);悬浮红细胞在切变率200/s、切变率30/s时的全血黏度分别为3. 08±0. 58 mPa·s和3. 91±1. 05 mPa·s,较静脉血降低,差异均有统计学意义(P=0. 020,0. 041)。结论术中自体回收红细胞保持了良好的抗聚集能力和变形能力,能为气体交换提供足够的交换面积并变形通过毛细血管为组织供氧。综合考虑回收红细胞同时具有良好的携氧、释氧能力以及流变学性质,在术中需要输注红细胞时应首选自体回收红细胞。     

Impact of intraoperative red blood cell salvage on transfusion requirements and outcomes in radical prostatectomy

BACKGROUND: Preoperative autologous blood donation lowers preoperative hemoglobin (Hb) levels, and the collected blood is frequently wasted. Intraoperative red blood cell (RBC) salvage provides fresher autologous blood in proportion to surgical blood loss, making cell salvage (CS) in radical prostatectomy (RP) feasible for study.
STUDY DESIGN AND METHODS: This retrospective study compared two strategies to reduce allogeneic RBC transfusion requirements in RP: preoperative autologous donation (PAD) versus CS. Patients underwent RP by one surgeon at one institution during two comparable time periods in 2005 (PAD—Group 1) and 2006 (CS—Group 2).
RESULTS: Group 1 patients (n = 40) underwent PAD, collecting 63 autologous RBC units; 36 units (57.1%) were reinfused and 27 (42.9%) were wasted. No Group 1 patient received allogeneic blood. Group 2 patients (n = 63) underwent intraoperative CS and received a mean of 287 mL of salvaged blood. In Group 2, two patients (3.2%) with preoperative Hb levels too low to permit autologous donation each received 2 units of allogeneic RBCs. Group 1 patients had significantly lower preoperative (−1.4 g/dL) and postoperative (−0.8 g/dL) Hb values compared to the CS group. There were no significant differences between groups in procedure times, length of stay, or numbers of cancer recurrences over the 24- to 36-month follow-up period.
CONCLUSION: Perioperative CS can effectively replace PAD for RP patients, offering similar avoidance of allogeneic transfusion, with greater convenience and superior postoperative Hb levels.     

骨科手术中回收血红细胞与患者麻醉前红细胞携氧能力的比较

[目的]比较骨科患者术中回收血红细胞与麻醉前红细胞携氧能力的差异.[方法]使用血液回收机对30例骨科手术患者行术中自体血液回收.取血液回收机处理后的回收血和麻醉前患者外周血各30份,检测两组血样的pH、根据公式计算血样的50%氧分压(P50),采用放射免疫法测定红细胞内2,3-二磷酸甘油酸浓度(2,3-DPG)、在血液...     

Costs associated with blood transfusions in Sweden--the societal cost of autologous, allogeneic and perioperative RBC transfusion

Anaemia is characterised by an insufficient number of red blood cells (RBCs) and might occur for different reasons, e.g. surgical procedures are often with associated blood loss. Patients who suffer from anaemia have the option of treatment with blood transfusion or medical treatment. In this study, the societal cost, for the case of Sweden, of RBC transfusion using three different techniques, i.e. allogeneic, autologous and intraoperative transfusion, was estimated. The analysis was based on information from interviews with hospital staff at large Swedish hospitals and from published data. The average cost for a 2 units transfusion was found to be Swedish kronor (SEK) 6330 (702 Euro) for filtered allogeneic RBCs and SEK 5394 (598 Euro) for autologous RBCs for surgery patients. Transfusion reactions accounted for almost 35 per cent of the costs of allogeneic RBC transfusions. The administration cost was found to be much higher for autologous transfusions compared with allogeneic transfusions. The cost of intraoperative erythrocyte salvage was calculated to be SEK 2567 (285 Euro) per transfusion (>4 units).     

不同自体输血方式的临床效果研究

目的 探讨不同自体输血方式的有效性,促进医疗机构开展自体输血工作,保障临床输血安全.方法 采用简单随机抽样法随机选择2014年1月至2016年7月,于北京军区总医院或大连中心医院行骨科手术的88例自体输血患者作为研究对象.采用简单随机分组法,将其随机分为,术中自体红细胞回输组(n=43),储存式自体全血回输组(n=25)及储存式自体单采红细胞回输组(n=20).采用简单随机抽样法,选择同期42例于受试者收集医院行骨科手术,并且术中仅接受异体输血的患者,纳入对照组(n=42).记录并分析采血前/术前、输血后当天、输血后第4天,各组患者红细胞计数、血红蛋白(Hb)水平、血细胞比容(HCT)、血小板计数,以及患者住院天数、术中出血量、异体输血量等指标.采用统计学方法比较4组患者上述各项指标的差异.结果 ①本研究4组患者采血前/术前的红细胞计数、Hb水平、HCT、血小板计数分别比较,差异均无统计学意义(P＞0.05).②输血后当天:4组患者的红细胞计数、Hb水平、HCT分别比较,差异均无统计学意义(P＞0.05);4组患者的血小板计数比较,差异有统计学意义(F=4.157,P=0.008).其中,储存式自体全血回输组患者的血小板计数最高[(196.0±43.8)×109/L],高于术中自体红细胞回输组、对照组,并且差异均有统计学意义(P=0.004、0.009);但是,与储存式自体单采红细胞回输组比较,差异无统计学意义(P=0.653).③输血后第4天:4组患者的红细胞计数比较,差异无统计学意义(P＞0.05);4组患者的Hb水平比较,差异有统计学意义(F=3.764,P=0.013).其中,术中自体红细胞回输组的Hb水平最高[(115.6±23.8)g/L],高于储存式自体全血回输组及对照组,并且差异均有统计学意义(P=0.022、0.006);但是,与储存式自体单采红细胞回输组比较,差异无统计学意义(P=0.878).4组患者的HCT比较,差异有统计学意义(F=3.915,P=0.011).其中,储存式自体单采红细胞回输组HCT最高[(34.4=4.8)％],高于对照组,并且差异有统计学意义(P=0.012);但是,与储存式自体全血回输组及术中自体红细胞回输组分别比较,差异均无统计学意义(P=0.059、0.819).④4组患者术中出血量和异体输血量分别比较,差异均无统计学意义(P＞0.05).4组患者住院天数比较,差异有统计学意义(x2=11.990,P=0.007).其中,对照组患者的住院天数最长[14.5 d(9.5～16.0 d)],长于储存式自体全血回输组,并且差异有统计学意义(P=0.007);但是,与储存式自体单采红细胞回输注及术中自体红细胞回输组分别比较,差异均无统计学意义(P=0.09、0.944).结论 临床择期外科手术患者的自体输血方式,首选储存式自体单采红细胞回输,其次为储存式自体全血回输和术中自体红细胞回输.在不能达到自体输血要求时,可选择异体输血.临床医师需要转变观念,逐步降低异体输血率,广泛、有效地开展自体输血工作,进一步保障临床输血安全.     

Intraoperative blood salvage: medical controversies

Although a great deal has been learned about the medical aspects of intraoperative blood salvage, several fundamental medical issues remain controversial. As pressure increases to maximize the use of IBS, more research will be needed on the application of salvage techniques in cancer surgery and in the presence of bacterial contamination. The reintroduction of the use of devices that do not wash salvaged blood have reopened investigations into the effects of reinfusion of partially hemolyzed and partially clotted salvaged blood on coagulation, renal function, and cardiopulmonary performance. More studies are also needed so that empirically based standards of practice for the collection and storage of salvaged blood can be established. No longer confined to a few pioneering surgical departments, IBS is now widely practiced and likely to continue to grow rapidly. Knowledge and research of the medical issues surrounding its use will become increasingly valuable in transfusion medicine.