加压输血的临床研究

对近年来临床上有关加压输血的方法，如一次性输血器、塑料三通辅助、袖带加压、输液泵等进行综述，提出加压输血器的研制还有待于改善和推广。     

塑料三通辅助快速加压输血的新方法

<正> 目前临床所用的输血器无法行快速加压输血。虽然静穿刺针改用进口留置针,提高了输血速度,但是在创伤急救、术中大出血时,速度仍嫌慢。而输血器无法挤压,挤压输血袋又有连接针脱落和空气进入血液循环的危险。作者利用塑料三通成功地解决了这一问题。     

两种加压器用于加压输血对红细胞破坏的比较研究

在临床护理工作中，特别是在手术室、急诊科抢救失血性休克病人时常常需要快速输血，以达到纠正或补充失血、防止休克的目的。目前使用的加压器主要有加压输血器和输液泵。加压输血器对软包装非常适合，具有快速、方便、省人力的优点，而输液泵则多用于硬瓶包装的血液(如自体血的回输)，其优点是准确、快速、安全、省人力，两种加压器均能有效地快速输血，以达到快速补充血液的目的。     

改良型排气泡输血器的研制及其在加压恒温加热输血手术患者中的应用

目的 制作一种改良型排气泡输血器,并验证其在加压恒温加热输血手术患者中的应用效果。方法 选取某三级甲等医院外科及妇产科各种原因失血急需输血的手术患者为研究对象,按时间先后顺序分为观察组40例,对照组38例,在排出输血器管路气泡时,观察组采用改良型排气泡输血器排出气泡,对照组采用普通输血器,传统方法排出气泡,比较2组各时点近心端输血管气泡析出率,排气泡时间,以及损失血液量。结果 近心端输血管气泡析出率,观察组各时点均低于对照组（P<0.01）;观察组各时点气泡析出率与其前一时点比较差异无统计学意义（P>0.05）。而对照组气泡析出率与其前一时点比较差异有统计学意义（P<0.01）。观察组排出气泡时间短于对照组（P<0.05）;观察组损失血液量少于对照组（P<0.05）;结论 改良型排气泡输血器能够降低近心端输血管气泡产生,缩短排气泡时间,减少损失血液量,降低气泡造成的安全隐患。     

袖带式加压输血器在手术中的应用

众所周知,加压输血器可用来抢救大出血或严重缺血的休克患者,它能使输血袋中的血液在最短的时间内进入患者体内,从而迅速改善患者的缺血状态。我们把用加压输血器输血的方法应用于颈椎管扩大成形术的手术配合中,取得了较好的效果,现报道如下。材料袖带式加压输血器1个,无菌生理     

加压输注去白细胞全血过程中血钾浓度变化的实验研究

[目的]观察加压输注去白细胞全血中血钾浓度的变化.[方法]选用人去白细胞全血,连接输血器及不同型号静脉留置针(18G、20G、22G、24G),测定不同压力(100 mmHg、200 mmHg、300 mmHg)下血液流经针头末端后血液中血钾浓度的改变.[结果]不同压力下血液流经输血器及不同型号静脉留置针血钾浓度变化经方差分析,差异无统计学意义(P>0.05).[结论]在压力300 mmHg以内,采用18G、20G、22G、24G静脉留置针输血,短时间内血液中血钾浓度无明显变化.     

加压输注去白细胞全血过程中血钾浓度变化的实验研究

[目的]观察加压输注去白细胞全血中血钾浓度的变化。[方法]选用人去白细胞全血,连接输血器及不同型号静脉留置针（18G、20G、22G、24G）,测定不同压力（100mmHg、200mmHg、300mmHg）下血液流经针头末端后血液中血钾浓度的改变。[结果]不同压力下血液流经输血器及不同型号静脉留置针血钾浓度变化经方差分析,差异无统计学意义（P〉0．05）。[结论]在压力300mmHg以内,采用18G、20G、22G、24G静脉留置针输血,短时间内血液中血钾浓度无明显变化。     

介绍一种快速加压输血器

加压输血是抢救出血性休克的重要措施之一。要在短时间内将大量的血液输入体内,必须有一套适用的快速输血装备。在中华妇产科杂志1964年第10卷第1期肖明钦所写“静脉加压快速输血在产科的应用”一文的启发下,在该文介绍的加压输血器的基础上,经多次研究改进,我们试制成功了一种快速静脉加压输血器,经临床试用,效果良好。一、加压输血器的构造:(附图)加压输血器的装置与一般静脉输液装置相同,仅以特制的玻璃瓶(以下简称小瓶)代替麻斐氏滴管(附图)。小瓶长14.5厘米,直径4厘米,上有刻度,容量为150毫升,共有5个管口。管“1”、“2”各长3.5厘米,直径1厘米,近管口处有三条小沟,使接橡皮管用线捆扎后不至     

标有刻度的一次性输液或输血器的研制

一次性输液或输血器是临床常用的一种医疗用品,不同厂家生产的输液或输血器长短、粗细不同,输液或输血器内能容纳液体量也不尽相同。现有的一次性输液或输血器外观没有容量刻度标志,在临床输液或输血过程当中,输液或输血器中能存留多少毫升液体,拔针时输液或输血器内都会残留部分液体,损耗多少毫升液体也不清楚,记录液体输入量不够精准,尤其是婴幼     

去除白细胞在临床输血中的效果分析

输血是抢救和治疗疾病必不可少的手段,不同程度的失血或贫血对输血数量和次数的要求都不一样。反复多次输血,易产生由同种免疫反应引起的发热性非溶血性输血反应并大多与输入的白细胞有关。本文采用滤除白细胞输血器(简称白细胞滤器)过滤后输血与单用一次性管道输血器输血来     

静脉输血的护理进展

为达到安全输血的目的 ,介绍了输血前的准备、输血速度、血液的保存温度与输注温度及其保证输血快速通畅护理 ,总结了常见输血并发症的防治。     

Improvement in transfusion safety using a specially designed transfusion wristband

Fatal haemolytic transfusion reaction due to ABO incompatibility occurs mainly as a result of clerical error. A blood sample drawn from the wrong patient and labelled as another patient's will not be detected by the blood bank unless there is a previous ABO grouping result. We report here the detection of such clerical error by the use of a specially designed transfusion wristband. The wristband has the following special features: (i) once attached, it cannot be removed except by cutting; (ii) it has a pocket containing a transfusion label; (iii) a unique transfusion barcode is printed on each transfusion label and the corresponding wristband simultaneously by computer technology; (iv) a transfusion label removed from the wristband after attachment to the patient has a characteristic tear-mark distinguishing it from one removed prior to attachment. The blood bank only accepted those specimens bearing the tear-marked transfusion labels. All blood units for this patient were labelled with this unique transfusion code together with the patient's details. The nurses counter-checked the transfusion code on the blood units against the transfusion code on the patient's transfusion wristband prior to transfusion. If the blood sample for compatibility testing was drawn from the 'wrong' patient, the intended patient either did not carry a wristband or the transfusion codes did not match at all. Pretransfusion compatibility tests were performed on 2189 patient samples using this procedure. It was well accepted by both ward and blood bank staff. Two potential mismatched transfusions were avoided. These two clerical errors would not have been detected because neither patient had previous ABO grouping results.     

Would doctors dream of electric blood bankers? Large language model-based artificial intelligence performs well in many aspects of transfusion medicine

Background

Large language models (LLMs) excel at answering knowledge-based questions. Many aspects of blood banking and transfusion medicine involve no direct patient care and require only knowledge and judgment. We hypothesized that public LLMs could perform such tasks with accuracy and precision.

Study Design and Methods

We presented three sets of tasks to three publicly-available LLMs (Bard, GPT-3.5, and GPT-4). The first was to review short case presentations and then decide if a red blood cell transfusion was indicated. The second task was to answer a set of consultation questions common in clinical transfusion practice. The third task was to take a multiple-choice test experimentally validated to assess internal medicine postgraduate knowledge of transfusion practice (the BEST-TEST).

Results

In the first task, the area under the receiver operating characteristic curve for correct transfusion decisions was 0.65, 0.90, and 0.92, respectively for Bard, GPT-3.5 and GPT-4. All three models had a modest rate of acceptable responses to the consultation questions. Average scores on the BEST-TEST were 55%, 40%, and 87%, respectively.

Conclusion

When presented with transfusion medicine tasks in natural language, publicly available LLMs demonstrated a range of ability, but GPT-4 consistently scored very well in all tasks. Research is needed to assess the utility of LLMs in transfusion medicine practice. Transfusion Medicine physicians should consider their role alongside such technologies, and how they might be used for the benefit and safety of patients.     

影响单位液量滴数相关因素的实验研究

目的 为能更准确计算单位时间内输入的液体量、药物、调节输液速度、估计输液时间提供依据。方法 分别实验记录同一厂家生产的一次性输液器、输血器、不同型号的针头、不同液体、不同输液速度影响下，15滴(跗)液体的量、lml液体的滴数，分别与传统15滴=1ml和1ml=15滴相比较，同时比较上述因素影响下lml液体滴数的差异。结果受上述因素影响，不同因素影响下lml液体的滴数差异也存在极显著性(P＜O．001)。结论临床使用一次性输血器输一般晶体液以23．5GTT／1 ml的关系换算，一次性输液器输一般的晶体液以19～21gtt／1 ml换算为宜。     

胸腔血自体回输在抢救创伤性血胸中的应用

目的：探讨在抢救创伤性血胸患者时胸腔血自体回输的方法及其安全性和可操作性。方法：对2005年3月～2007年11月收治的54例创伤性血胸患者利用胸腔闭式引流，一次性采血袋、输血器将血液回输。结果：52例经过使用上述方法后失血性休克得到纠正，生命体征平稳，获得了进一步治疗的时机。2例严重多发伤虽经积极抢救仍无法挽回生命。全部病例均未出现自体输血引起的并发症。结论：对中等量以上、无明显污染的胸腔血自体回输是一种安全、有效、经济、方便的方法。     

控制非适应证输血研究

目的研究控制非适应证输血对临床输血合理性的影响,探讨提高临床输血合理性的有效方法。方法回顾性分析控制非适应证输血前(2005年)和控制非适应证输血后(2006年)临床输血适应证符合率及使用血液成分构成比的变化。结果2005年和2006年临床输血适应证符合率分别为66.6%和89.7%,P<0.05;红细胞使用率分别为34.9%和45.8%,P<0.05;血浆使用率分别为41.9%和26.6%,P<0.05。结论控制非适应证输血可有效提高临床科学、合理用血水平。     

输血前Rh(D)检测及其在输血中的意义

探讨输血前检测受血Rh血型的意义及对Rh(D)阴性能及时输用同型血或采用自体输血的可能性。对近5年来住院治疗首次申请输血的病人共2168例，在输血前1天进行Rh(D)血型抗原的检测，应用BASO公司生产的IgM抗—D血清，采用试管法进行检测。结果表明：在2168例病人中检测出Rh(D)阴性7例，Rh(D)阴性率占0．32％，其中2例采用自体输血，2例输用ABO同型的Rh(D)阴性血液，3例未输血。结论：输血前检测Rh(D)血型能防止溶血性输血反应；如果病人是Rh(D)阴性，只要身体条件允许可采用自体输血。     

静脉输液的影响因素分析与动态观察

阐述了影响静脉输液的变化因素,如输液系数变更的影响因素,液体静压对输液速度的影响,体位变化的影响,液体与穿刺点的垂直高度的影响;提出动态观察与调节静脉输液的必要性,并介绍了一种为动态、连续性观察输液全过程而设计的行之有效的输液观察记录卡。     

Home blood transfusion: a necessary service development

An alternative to the transfusion of blood and platelets in hospital was assessed with the aim of reducing the demand on acute services and the need for hospital admission. Patients and general practitioners [GPs] were surveyed before a home blood transfusion service was set up. The majority of GPs and patients did not support the scheme initially. After the service was set up, all patients who received home transfusion stated that this was more convenient. We feel that by avoiding unnecessary emergency admissions, which account for up to 40% of all admissions to NHS hospitals, and improving the capacity of our day unit, we are providing a better service for local patients. More widespread use of home transfusion services should be encouraged.     

Hematologic Safety of Intraosseous Blood Transfusion in a Swine Model of Pediatric Hemorrhagic Hypovolemia

Objective: To assess the risk of hemolysis, disseminated intravascular coagulation (DIC), or fat embolism syndrome (FES) with pressurized intraosseous (10) blood transfusion following hemorrhage.
Methods: A controlled, repeated-measures, randomized animal study with blinded pathologic evaluations was conducted. Sixteen pento-barbital-anesthetized, instrumented immature swine underwent a 20-mL/kg hemorrhage into citrate-phosphate-dextrose bags, then received autologous blood transfusion via a 16-ga IV catheter (eight), or via a 15-ga 10 needle in the proximal tibia (eight) under maximal manual pressure using a 30-mL syringe. At baseline and at one hour and 48 hours posttransfusion, blood samples were assayed for hemoglobin (Hb), schistocytes, free Hb in plasma, bilirubin, lactate de-hydrogenase, platelets, fibrinogen, and alveolar-arteriolar O₂ gradient. Lung sections were examined for inflammation after hematoxylid eosin stain, and for fat emboli after oil red-O-stain. Kidney sections were examined for inflammation using hematoxylin/eosin stain.
Results: Though the 10 transfusion rate of 21 ± 6 mumin was slower than the IV rate of 35 ± 5 mL/min (p = 0.0012), all the animals returned to baseline blood pressure within 15 minutes and survived. The presence of schistocytes and mildly elevated free Hb in plasma was noted in both groups at baseline and each time period, and was presumed to be due to sampling from the arterial catheter. All other laboratory values remained within normal limits and without inter-group differences at any time period. No fat embolus was noted, and all lung and kidney specimens were free of inflammation.
Conclusions: In this model, pressurized 10 blood transfusion appears to be hematologically safe, i.e., without risk of appreciable hemolysis, DIC, or FES.