自体输血研究进展

由于异体输血可发生各种并发症，自体输血日益为医、患所接受。阐述了自体输血技术的研究进展，进一步证实了其在临床应用的可行性，也指出了在它在发展中所面临和急需解决的总理２。     

自体和异体输血患者的效果观察

异体血液输注不可避免地带来一些不良影响 ,如乙型病毒性肝炎、丙型病毒性肝炎和艾滋病 (AIDS)等血源性疾病的传播及各种输血反应 ,包括溶血反应、同种免疫和非溶血发热反应 ,还可引起机体免疫抑制 ,增加癌症复发率 ,术后感染 ,缩短生存时间。近年来我们指导临床采用自体输血的方法抢救、治疗患者 ,取得满意效果 ,现报告如下。1　资料与方法1 1　临床资料　选择市医院外科作为指导重点。自 2 0 0 0年 1月至 2 0 0 1年10月输血病例中 ,随机抽取 5 0例分为A、B两组 ,A组 2 5例为自体输血者 ,B组 2 5例为异体输血者。 12～ 78岁 ,平均 37岁…     

自体输血在外科手术中的应用体会

随着输血技术在临床治疗的广泛应用，节约用血和安全输血已成为输血工作中的一个重要课题。由于异体输血有传播疾病的危险并可能伴随各种不良反应，所以自体输血代替异体输血成为当前患者手术治疗的首选输血方案。特别是术前贮血可使许多手术患者得以安全的临床治疗。同时又可以确保稀有血型患者的血源。笔者对我院近两年术前自身输血的应用与体会报告如下。     

贮存式自体输血在心脏外科手术中的应用

目的探讨贮存式自体输血(predeposit autotransfusion,PAT)在不同心脏外科手术患者中的应用效果。方法选取不同心脏外科手术前应用PAT者48名,比较其术前采血与术后RBC、Hb、Hct、Plt变化;同时选取不同心脏外科手术前异体输血(homologous blood transfusion,HBT)者48名,比较2组间术前采血与术后RBC、Hb、Hct、Plt指标的变化差异。结果不同心脏外科手术患者采取PAT,其术前采血与术后RBC、Hb、Hct、Plt变化有统计学意义(P<0.05),与出院前相比较差异无统计学意义(P>0.05);PAT与HBT 2组比较,术前及术后RBC、Hb、Hct、Plt之间变化均无统计学意义(P>0.05)。结论血液学检测指标显示,不同心脏外科手术患者术前PAT或HBT效果相同。     

储存式自体输血的68例临床应用分析

自体输血在手术中的应用，既可节约用血，又达到了安全输血的目的，已成为临床输血的一项重要工作，可避免异体输血传播疾病和多种输血：不良反应。本科自1998年5月以来，对68例择期手术病人进行术前预存自体血200ml～800ml，术中或术后回输，取得较好的疗效。现报告如下。     

利用血液回收机术中自体输血

为了节约血源,减少输血并发症,笔者对大手术中出血>500ml(不含心脏体外循环)的患者使用血液回收机施行自体输血,报告如下. 1 材料与方法 1.1 临床资料 1999年11月～2000年6月入本院手术患者24名.男性21例,女性3例.年龄21～7     

心脏瓣膜置换术患者应用改良贮存式自体输血和异体输血的效果比较

目的 对比改良贮存式自体输血和异体输血对心脏外科瓣膜置换术患者手术及术后恢复的影响,确定改良贮存式自体输血采血法在心脏外科手术中应用的效果.方法 选取2013年1～5月本院行心脏瓣膜置换术的择期手术患者200例,其中使用改良贮存式自体输血采血法进行术前自体备血的患者100例,年龄21～73岁,心功能分级Ⅱ～Ⅲ级,采血前平均Hb为（147.34＆#177;12.69） g/L,Hct为（43.41土3.72）％;使用异体血术前备血的患者100例,年龄18～71岁,心功能分级Ⅱ～Ⅲ级,术前平均Hb为（133.93＆#177;25.94） g/L,Hct为（38.24＆#177;9.41）％,对比两组患者在围术期各项指标的差异.结果 100例改良贮存式自体输血组使用血液总量319U,100例输注异体血组使用血液655U,两者相比,自体输血组手术血液使用总量、平均异体红细胞量、平均异体血浆量均明显降低（P＜0.05）.自体输血组采血后血红蛋白浓度、红细胞压积轻度降低,但在正常范围内.术后1d血红蛋白浓度及红细胞压积均明显高于异体输血组患者,差异具有统计学意义（P＜0.05）.出院前血红蛋白浓度、红细胞压积两组患者比较差异不明显;自体输血组患者术后到出院的平均时间为（6.58＆#177;1.9）d,异体输血组患者为（10.01＆#177;3.87）d,差异有统计学意义（P＜0.05）.使用改良贮存式自体输血的患者术后未发生感染,而异体输血组患者术后感染率为3％.同时自体输血组患者的住院成本明显降低（P＜0.05）.结论 改良贮存式自体输血采血法,较异体输血法对红细胞破坏少,血液输注量少,患者术后各项指标恢复快,感染率低,经济实用,可广泛应用于心脏外科瓣膜病等择期手术.     

自体输血也要三思而后行

输血在外科领域中广泛应用的同时也带来了一些不良反应甚至严重的并发症，特别是在某些紧急情况下输入他人血液(异体输血)时，可能会感染肝炎、艾滋病等血液传播疾病，即使在血液管理较规范、供血较安全的发达国家也不能完全避免。而现在备受青睐的自体输血，被认为是最安全可靠的输血方式。所谓自体输血，是在术前条件允许的情况下或手术中收集病人自身的血液以备手术需要之用。     

台州市中心医院自体输血在临床外科手术中的应用评价

随着临床外科手术的不断发展,术中输血量与日俱增,而血站血源又频频告急,临床用血供需矛盾日益显现.同时,我们又经常看到术中大量出血未能充分回收利用,造成了血液资源的极大浪费.为缓解临床供血压力,确保外科手术顺利进行,本院近几年来大力宣传和推广自体输血,取得了较为显著的成果,自体输血率稳步攀升,目前外科科室自体输血率已达到35％左右,全院自体输血率也接近15％.现具体报道如下.     

回收式自体输血在脊柱外科手术中的应用

目的　探讨术中回收式自体输血技术在脊柱外科手术中的作用及优点。方法　将 2 0 0 1年 1月～ 2 0 0 3年 3月 ,1 5 8例行脊柱手术并接受输血的患者分为实验组 ( 71例 )和对照组 ( 87例 )。实验组采用术中自体血回收 ,对照组使用异体输血。比较两组病例的异体输血量、术后血红蛋白值、输血后并发症的发生率。结果　实验组患者平均输入异体血 ( 1 79± 4 0 .2 )ml,对照组患者平均输入异体血 ( 795± 6 9.9)ml,两组间差异显著 (P <0 .0 5 ) ;两组术后各时相点的血红蛋白值无显著差异 (P >0 .0 5 ) ;实验组中仅应用自体血回收技术的患者无任何并发症发生。结论　行脊柱融合、内固定等大中型手术时出血量较大 ,采用术中自体血回输技术可以明显减少异体输血量及由此引起的各种异体输血后并发症的发生。     

自体血液回输技术的临床应用

目的探讨术中自体血液回输的安全性和效果．方法用自体血液回收机将术野出血回收，经抗凝、过滤、清洗、浓缩后回输。抽取术前静脉血、术中回收血、术后静脉血，进行血常规化验、血液生化检验和血浆电解质检查。结果30例患者平均每例回收原血1028ml，经血液回收机处理后获得浓缩血532ml，均回输给病人。术后血常规、多项血生化检查及血浆电解质检查结果变化不明显。结论自体血液回收机能有效减少术中血液的丢失，减少输血后的并发症及不良反应。     

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。     

Pre-operative autologous blood donation and transfusion-related adverse reactions: A 14-year experience at a university hospital

Objective

The objective of this study was to determine the rate of adverse reactions to pre-operative autologous blood donation (PAD) transfusion in a single institution over a 14-year period.

A survey of autologous blood transfusion practices in Germany

This survey was designed to evaluate the use of autologous blood transfusion techniques in Germany in 2000 and to identify how the use of these techniques has changed over the past 5 years. Questionnaires were mailed to the chief anaesthesiologists of 400 randomly selected German hospitals with > or =25 surgical beds. Information was sought about the current and past use of preoperative autologous blood donation (PABD), acute preoperative haemodilution and peri-operative blood salvage. Data were requested for the calendar year 2000. Three hundred and forty-three (86%) completed questionnaires were returned. PABD, haemodilution and peri-operative blood salvage were used by 85, 54 and 67% of respondents, respectively. Thirty-seven per cent of PABD users reported that PABD use declined, 28% reported that it increased and 34% reported that it remained unchanged over the past 5 years. The proportions of those reporting declining vs. increasing use of PABD did not differ significantly (P = 0.09). Sixty per cent of users of haemodilution reported that its use declined, 10% reported that it increased and 29% reported that it remained unchanged over the past 5 years. Sixteen per cent of hospitals that were equipped with cell-washing devices reported that the use of these devices declined, 47% reported that it increased and 37% reported that it remained unchanged over the past 5 years. The results indicate that autologous blood transfusion techniques were widely used in Germany in 2000, with PABD being the most common technique. The use of PABD did not change significantly, the use of haemodilution declined markedly and the use of peri-operative cell salvage increased markedly during the past 5 years before the survey.     

Safety and efficacy of unmodified whole blood vs. buffy coat-depleted red cell concentrates in autologous transfusion of elective orthopaedic surgery patients

Storing autologous blood as whole blood (WB) has been proposed for increasing the cost-effectiveness of preoperative autologous blood donation programmes. However, experimental data suggest that autologous leucocytes might lead to immunomodulation similar to the effect attributed to allogeneic leucocytes. In a retrospective analysis, the postoperative outcome of 120 patients undergoing elective orthopaedic surgery and having donated up to two units of autologous WB (AWB) was compared with that of a control group of 52 patients, whose autologous donation had been processed into buffy coat-depleted red cell concentrates (RCC). At least one autologous unit, but no allogeneic units, had been transfused in all analysed patients. Donation schemes were equally efficacious in both groups. There was no significant difference in postoperative infection rates between the two groups. Overall rates were 7.7% in the RCC group and 8.3% in the WB group. Surgical, thromboembolic and other recorded complications, length of postoperative hospital stay and days of the use of antibiotics were also not significantly different between the two groups. The results of this study suggest that transfusion of up to two units of unmodified AWB is as efficacious as the transfusion of autologous RCC and does not negatively influence the postoperative outcome in elective orthopaedic surgery.     

Evaluation of awareness and utilization of an autologous blood transfusion programme

Autologous blood transfusion (ABT) has an important role in transfusion practice in the developing world due to increasing incidence of HIV and hepatitis C virus infection. Our study was done to evaluate the level of awareness and utilization of an autologous blood transfusion programme in a teaching hospital in Delhi. We assessed the level of awareness of preoperative ABT amongst treating physicians from different specialties in a teaching hospital through an anonymous questionnaire. The utilization of this methodology in transfusion practice was estimated from records of the Blood Transfusion Service.
Of the 150 doctors contacted 96 (64%) responded. Although 67.7% of them were aware of the technique and its advantages, only 21.8% used it for the patients under their care. In the preceding 24 months 133 (1.1%) of 12 090 blood collections in the transfusion service were from autologous donor-patients. Only one unit of blood was collected from each patient, although 41.8% of them received  2 units of blood. Of the 11 123 patients transfused, 55 (0.49%) received the ABT. Thus only 55 (41.3%) of 133 total ABT collections were utilized. The study highlights that there is a general lack of awareness about ABT amongst physicians. This transfusion practice is rarely and inadequately used. The study was repeated the following year after an intensive intervention strategy was adopted. The results show a trend towards improvement in the practice of ABT. This study emphasizes the need for proper organization, planning and communication between clinicians and blood transfusion personnel for effective implementation of an ABT programme, especially in countries with a high incidence of transfusion-transmitted infections and acute shortages of blood for transfusion.     

自体血回输在异位妊娠内出血中的运用（附17例分析）

目的 探讨自体血回输在异位妊娠内出血急诊手术中的运用价值.方法 2004年10月至2005年10月,采用京精-2000型自体血液回收机对17例异位妊娠内出血病人进行术中自体血回输.分别记录术中出血量和回收血量.结果 17例患者共回收自体血24053ml,回输血12290ml,所有患者均顺利恢复,无自体输血相关并发症.结论 异位妊娠内出血急诊手术中运用自体血液回输安全有效,可迅速获得大量新鲜红细胞,有效地维持循环,减少术中血液丢失,减少异体血输入量和降低输血后并发症,提高抢救成功率.     

自体血回输与急性等容量血液稀释对脊柱外科手术患者全身炎症反应的影响

目的自体血回输与急性等容量血液稀释对脊柱外科手术患者全身炎症反应的影响。方法将60例脊柱外科手术患者,随机分为对照组、自体血回输组、急性等容量血液稀释组,每组20例。对照组在术中出血多时就输入异体库存血。自体血回输组在术中联合使用自体血回收装置,血红蛋白低下时就输库存血。急性等容量血液稀释组先经外周静脉输入一定晶体液或胶体液,再经颈内静脉缓慢的抽出机体血液装入专用的含有抗凝的血袋内,经血液摇摆机不停地摇动,适当的时候输入。术前(T1)、术后2h(T2)、6h(T3)、12h(T4)及24h(T5)各时间点抽血5mL,检测白细胞(WBC)、白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)水平,记录术后有无并发症。结果自体血回输组和急性等容量血液稀释组回收血WBC计数均高于T1检测结果,差异有统计学意义(P0.05);3组患者在T2～T5时间点血清IL-6、TNF-α及WBC水平与T1时间点检测结果比较显著增高,但均明显低于对照组,差异有统计学意义(P0.05);术后随访无一例并发症。结论自体血回输组和急性等容量血液稀释组可以有效降低术中及术后全身炎症反应,明显节约血资源。     

34例异位妊娠破裂伴失血性休克术中自体血回输的临床应用

目的：探讨自体血回输在异位妊娠破裂伴失血性休克术中的临床应用价值。方法：我院2010-05-2012-05采用自体血液回输机对34例异位妊娠破裂伴失血性休克患者在术中进行自体血回输,分别记录术中出血量和回输血量。结果：34例患者共回收自体血52940ml,回输血32130ml,所有患者术后恢复良好,无相关并发症。结论：异位妊娠破裂伴失血性休克术中运用自体血回输安全,可快速获得新鲜红细胞,有效维持血容量,减少异体血的使用,降低输血并发症,提高抢救成功率。