储存式自体输血在老年骨科患者手术中的应用观察

目的观察储存式自体输血在老年患者骨科手术中的应用效果。方法75例年龄65岁以上的择期手术骨科疾病患者患者,每天给予多糖口服补充铁剂。在采血前1h按采血量的三倍经外周静脉输注晶、胶体液体（晶、胶体液体量比例为2：1）,然后经另一静脉采血。每次采血400ml,间隔72h采血1次,总采血量不超过1200ml。结果7例患者因术中出血过多同时输注异体血外,其余患者均未输注异体血,术后恢复良好。患者采血前、后及回输前、后红细胞（RBC）、血红蛋白（HBG）、红细胞压积（HCT）、血小板（PLT）相比,P均〉0．05。结论储存式自体输血用于骨科老年患者手术,效果满意。     

储存式自体输血在Rh(D)阴性血型患者择期手术中的应用

目的:探讨储存式自体输血在Rh(D)阴性血型患者择期手术中的应用.方法:对78例Rh(D)阴性血型患者在术前3～9 d根据预计术中输血量分次采集自体血800～1200 ml.采血后患者口服多糖铁150 mg,tid同时适当加强营养.采集的血液置4℃贮血冰箱内保存备用.结果:78例患者中除4例因肿瘤巨大手术出血量过多,分别输异体悬浮红细胞3 U(2例),4 U(2例),其余病例均未输注异体血,手术获得顺利完成.检测患者采血前,后及回输后Hb、Hct值,经统计分析差异无统计学意义.结论:储存式自体输血对Rh(D)阴性血型患者在择期手术中是解决血源紧张的一种行之有效的方法,具有临床推广应用价值.     

储存式自体输血与去白细胞异体输血对骨科手术病人T细胞亚群及细胞因子影响的研究

目的观察与对比储存式自体输血和去白细胞异体输血对全膝关节置换术病人免疫系统的影响。方法本文选取全膝关节置换术患者60例,随机分为两组:储存式自体输血组(组Ⅰ)和去白细胞异体输血组(组Ⅱ),各30例。组Ⅰ患者于术前1周采血400ml,组Ⅱ患者术前配去白细胞悬浮红细胞400ml,两组均在术中完成全部血液输入。两组患者均分别于术前、术后第1天、术后第5天及术后第10天采静脉血,测定CD4+、CD8+、NK细胞数量及细胞因子IL-2与IL-6浓度。结果与术前相比,两组术后第1天CD4+、CD8+、NK细胞数量及细胞因子IL-2浓度均出现明显下降且组Ⅱ下降较为明显,而两组细胞因子IL-6均出现显著上升且组Ⅰ上升较明显,且均有统计学意义(P<0.05),术后第5天均基本回至术前水平,术后第10天组ⅠCD4+与NK细胞均较术前水平高且较组Ⅱ相比差异有统计学意义(P<0.05)。结论储存式自体输血可显著恢复全膝关节置换术后患者围手术期细胞免疫功能。     

储存式自体输血在前置胎盘孕妇中的临床应用

目的:探讨妊娠晚期储存式自体输血在前置胎盘孕妇中的应用价值。方法:选择2011-03-2015-06妇产科住院分娩的前置胎盘患者83例。在择期剖宫产终止妊娠前3周,每次采血200ml储存备用。采血前30min内和采血后2h内行患者血压、心率监测及胎心监护;采血前后监测孕妇血压、心率、呼吸情况;检测采血前后和自体血回输后红细胞(RBC)、血红蛋白(Hb)、红细胞沉降率(Hct)、血小板(PLT)、凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)等指标。结果:采血及回输过程中母胎一般情况良好,新生儿Apgar评分为9~10分。83例前置胎盘孕妇采血前后及分娩后血压、心率、呼吸均无明显变化(P0.05)。采血前后和自体血回输后RBC、Hb、Hct、PLT、PT、APTT等指标无显著变化(P0.05)。结论:妊娠晚期前置胎盘孕妇应用储存式自体输血安全性好,不会对母胎产生明显影响,具有一定的临床应用价值。     

前置胎盘孕妇的产前观察与护理

妊娠28周后,胎盘附着于子宫下段,甚至胎盘下缘达到或覆盖宫颈内口,其位置低于先露部,称为前置胎盘[1],是孕晚期阴道出血最常见原因。它起病急、进展快,如处理不及时或不当可威胁母儿生命。我院对2011—2012年收治的前置胎盘产妇98例的阴道出血进行了严密的观察,为其实施有效的针对性护理。现将临床观察与护理体会报道如下。1资料与方法1.1一般资料选择2011—2012年在我院诊断为前置胎盘患     

贮存式自体输血在自体骨髓移植中的应用

目的:探讨实行贮存式自体输血对自体骨髓移植的可行性.方法:10例自体骨髓移植在采血前按一定的要求合格后合采髓前2周左右,采集患者自体全血,每次采血200 ml～400 ml,2次采血间隔不少于5 d,最后1次采血应在移植前2 d完成,采集的血于4℃保存,待患者进行采髓时还输给患者.结果:10例患者共采集自体血7900 ml,无一例不良反应.在采髓回输过程中10例患者通过贮存式自体血顺利的完成采髓手术,无不良反应.结论:贮存式自体输血对自体骨髓移植是一种科学、安全、合理、经济、有效的输血方法,     

恶性肿瘤患者自体输血

目的：探索恶性肿瘤患者自体输血的可行性。方法：分析自体输血和异体输血对择期手术恶性肿瘤患者的影响。结果：肿瘤患者自体输血较异体输血,输血反应发生率、感染率和输血费用低。结论：对恶性肿瘤患者实施自体输血是可行的,既可节约血源又减少输血反应的发生和疾病传播,而且不需要检测血型和交叉配血,减少患者经济负担。     

介入治疗在凶险性前置胎盘剖宫产中应用的研究进展

介入治疗在多学科共同治疗凶险性前置胎盘中发挥了越来越重要的作用,它能有效减少胎盘剥离时的术中及术后出血量,减少对输血的要求及子宫切除的风险。该文对介入治疗在凶险性前置胎盘剖宫产中应用的研究进展作一综述。     

自体输血在临床上的应用

１９９８－０９－０８收稿１自身输血的概念自身输血即将自己的血预先储备，以后在需要输血的各种手术中进行自身回输。２临床意义自身输血在国外已开展了许多年，许多国家普遍认识到ＨＩＶ感染的危险，随着科学事业的发展，对与输血相关的疾病的了解也在增加，医生和病员都知道了输血可能带来的危险或威胁，它除了可能引起溶血反应、白细胞抗体反应、移植物抗宿主病、免疫抑制、癌症复发等副作用外，还可能传播肝炎病毒、艾滋病毒、巨细胞病毒及疟疾、梅毒、黑热病等。目前输同种血液给受血者带来的最大危险，在国外是艾滋病，在国内则是丙…     

术中自体输血150例效果观察

输血是现代医学重要的治疗手段之一 ,但由于异体输血存在着感染和传播疾病的危险 ,因此提倡自体输血。1 999年 9月～ 2 0 0 1年 9月 ,我院对 1 5 0例手术患者行术中自体输血 ,临床观察 ,效果满意。现报告如下。1　临床资料本组 1 5 0例患者中 ,男 86例 ,女 64例 ;年龄 1 0～ 69岁 ,平均 3 9.4岁。除 2例血气胸 ,3例肝脾破裂急诊手术外 ,余 1 45例均为择期手术。手术包括髋关节置换术 ,股骨陈旧性骨折接骨术 ,房缺、室缺修补术 ,肺叶切除术 ,纵隔肿瘤切除术 ,食管癌根治术 ,胃癌根治术 ,卵巢癌根治术 ,全子宫切除术 ,直肠癌根治术及肾切除术…     

No changes in infliximab levels in blood stored for preoperative autologous blood donation

Abstract

Rheumatoid arthritis (RA) patients requiring total joint arthroplasties under administration of infliximab, which may remain in donated blood if preoperative autologous blood donation (PABD) is undertaken for the surgery, may risk infection. We clarified infliximab hemokinetics in blood stored for such patients. A 20-ml blood sample was obtained from each of the ten RA patients receiving infliximab at just after administration and at 2 and 4 weeks following the administration of infliximab, mixed with 2.8 ml citrate-phosphate-dextrose-adenine (CPDA-1) and stored at 4–6°C. Plasma levels of infliximab in the stored blood were measured just after-mixture with CPDA-1, and at 2 and 4 weeks following the start of storage. Serum levels were also measured just before infliximab administration and at each phlebotomy. The plasma infliximab levels in the stored blood remained close to their original serum levels at the time of each corresponding phlebotomy, only somewhat influenced by dilution of CPDA-1, and sustained for 4 weeks following the start of storage, unlike in vivo, where levels decreased. This suggests that in order to prevent side effects, the later after infusion of infliximab the phlebotomy occurs, the better, and that the amount of stored blood transfusion should be consistent with that of blood loss.     

No changes in infliximab levels in blood stored for preoperative autologous blood donation

Rheumatoid arthritis (RA) patients requiring total joint arthroplasties under administration of infliximab, which may remain in donated blood if preoperative autologous blood donation (PABD) is undertaken for the surgery, may risk infection. We clarified infliximab hemokinetics in blood stored for such patients. A 20-ml blood sample was obtained from each of the ten RA patients receiving infliximab at just after administration and at 2 and 4 weeks following the administration of infliximab, mixed with 2.8 ml citrate-phosphate-dextrose-adenine (CPDA-1) and stored at 4–6°C. Plasma levels of infliximab in the stored blood were measured just after-mixture with CPDA-1, and at 2 and 4 weeks following the start of storage. Serum levels were also measured just before infliximab administration and at each phlebotomy. The plasma infliximab levels in the stored blood remained close to their original serum levels at the time of each corresponding phlebotomy, only somewhat influenced by dilution of CPDA-1, and sustained for 4 weeks following the start of storage, unlike in vivo, where levels decreased. This suggests that in order to prevent side effects, the later after infusion of infliximab the phlebotomy occurs, the better, and that the amount of stored blood transfusion should be consistent with that of blood loss.     

妊娠晚期前置胎盘67例临床分析

目的 探讨妊娠晚期前置胎盘发生的高危因素、诊断及有效分娩方式.方法 回顾性分析我院2007-08～2011-08产科收治的67例妊娠晚期前置胎盘患者的临床资料.结果 第一次妊娠者发生前置胎盘的比例较高;前置胎盘患者发生早产、产后出血、宫腔填纱的概率较高;前置胎盘误诊率及漏诊率较高.结论 对年轻孕妇病史采集需认真详细;终止妊娠前尽量明确胎盘位置,提高产前诊断率;低置性前置胎盘患者应尽量行阴道试产以降低剖宫产率及产后出血率.     

Preoperative autologous blood donation by elderly patients undergoing orthopaedic surgery

BACKGROUND AND OBJECTIVES: To assess the feasibility of a programme of predeposit in elderly patients undergoing elective orthopaedic surgery. PATIENTS AND METHODS: We retrospectively studied 789 elderly patient candidates (> 65 years of age) for orthopaedic surgery (total hip and knee replacement and spinal surgery), who were undergoing a programme of preoperative autologous blood donation (PABD) in our city hospital between January 1990 and December 1998. RESULTS: Six hundred and eighty-eight patients (87.2%) were transfused with autologous blood; 128 (16.2%) also received allogeneic blood. Hip arthroplasty revision was characterized by the greatest blood consumption. The predeposit programme was discontinued in 96 patients (12.2%) because of the following complications: the onset of anaemia (11.0%); vasovagal reactions (0.5%); lack of venous access (0.4%); or cardiac complications (0.2%). No episodes of reaction to autologous transfusion were recorded. CONCLUSIONS: Our study confirms the feasibility of PABD in elderly patients undergoing elective orthopaedic surgery.     

Autologous blood donation and transfusion in Europe

BACKGROUND AND OBJECTIVES: The aim of this study was to record practices in autologous blood transfusion in Europe in 1997. MATERIALS AND METHODS: A questionnaire mainly about predeposit was distributed to the National Representatives of all 41 member states of the Council of Europe's Committee of Experts on Blood Transfusion and Haematology. Replies were received from 29. RESULTS AND CONCLUSION: Autologous blood units collected in 1997 amounted to 4.2% of the allogeneic units, with wide variations between countries. Predeposit was used most frequently in Italy (8.9%), Germany (7.1%) and France (6.6%). Some countries, notably Scandinavia, do not encourage predeposit, chiefly on the grounds that it is not cost-effective, but others are promoting its use.     

The safety of blood donation by elderly blood donors

Background Due to the ageing population, blood donation by the elderly is necessary to maintain blood supply. We initiated a prospective study, to assess whether there is an increased risk of donor reactions in elderly donors. Study Design and Methods In this prospective study, regular donors aged from 66 to 68 and 69 to 71 years were invited to continue blood donation on mobile collection sites of the German Red Cross Blood Service West. A control group (50–52 years) was established. Admission of donors in all groups followed the German national guidelines for blood donation. Donor deferrals and all kinds of donor reactions during donation (on‐site) and in the 48 h following donation (off‐site) were monitored. Results A total of 64 260 valid cases were entered in the study. Donor deferrals increased with age from 1·12% in the control group up to 8·74 in female donors aged 69–71 years. Adverse reactions to blood donation were rare with an overall reaction rate of 0·63% (0·05% on‐site; 0·58% off‐site). Off‐site reactions significantly decreased with increasing age. The relative risk (RR) for adverse reactions in elderly donors compared to the control group (50–52 years) was slightly increased for on‐site reactions in the 69‐ to 71‐year‐old donors (RR 1·0309; 95% CI 1·0292–1·0325). In all other comparisons, the RR for adverse reactions was distinctively lower in elderly donors (RR 0·3785 – 0·7778). Conclusions Our data confirm that elderly regular blood donors may safely continue blood donation at least to the age of 71. Based on these data, we increased the upper age limit.     

An update on predeposit autologous blood donation and transfusion in Europe

BACKGROUND AND OBJECTIVES: The aim of this study was to update previous data on the practice of autologous blood transfusion in Europe. MATERIALS AND METHODS: A questionnaire, mainly about predeposit, was distributed to each National Representative on the Council of Europe's Committee of Experts on Blood Transfusion and Haematology. Detailed replies were received from 23. RESULTS: Predeposit autologous blood units collected in 2000 amounted to 3.3% of the allogeneic units, compared with 4.2% in 1997. Predeposit collection was commonest in Italy (7.8%) and Germany (6.4%). CONCLUSIONS: Although autologous transfusion showed no sign of increase in Europe from 1997 to 2000, the need for alternatives to allogeneic transfusion is growing. Policy and practices in this field should be followed on an ongoing basis.     

Hemagglutination of preoperative blood donation in patients with rheumatoid arthritis

Abstract

We gave preoperative blood transfusions to 37 patients with rheumatoid arthritis (RA) and 35 patients with osteoarthritis (OA), including some whose baseline hemoglobin level was less than 10?g/dl. Transfusion packs can preserve whole blood containing citrate phosphate dextrose (CPD) for 3 weeks. The baseline hemoglobin level of RA cases was 10.4?g/dl (range 8.4–13.1?g/dl), and that of OA cases was 11.9?g/dl (range 10.4–15.0?g/dl). By collecting 200–400?g every week before the operation, the total was 800–1200?g. Erythropoietin was given to patients intramuscularly when their hemoglobin was less than 13?g/dl after blood had been collected. Hemagglutination, with diameters of more than 1?cm, made filter occlusions in 11 RA cases (30%) and one OA case (3%) (P < 0.0031) after retransfusion. There were no differences between hemagglutination patients (agglutination group) and nonhemagglutination patients (nonagglutination group) regarding baseline C-reactive protein (CRP), white blood cells, platelets, or fibrinogen. We could not predict the formation of macrohemagglutination in the packs collected during the clinical course. In RA cases, allogenic transfusions were performed for four cases (36%) in the agglutination group and for one case (12%) in the nonagglutination group. Preoperative transfusion for the RA patients showed hemagglutination in some cases, and highlighted the need for modifications to reduce these hemagglutinations.