血液保护在颅脑外科手术中的应用和护理

目的探讨颅脑外科手术中血液保护的方法和护理特点。方法选择大、中型颅脑手术患者58例,按手术单双日顺序分为两组,各29例。单日患者不采集自体血为非血液保护组;双日患者于麻醉平稳后,从外周输入平衡液和明胶溶液,同时按10￣15 m l/kg采集患者自体血液为血液保护组。观察记录患者麻醉前、采血前5 m in、采血后5 m in、回输前5 m in、回输后5 m in、术毕时的血红蛋白、红细胞压积、平均动脉压、心率、动脉氧饱和度以及尿量,输血量。结果血液保护组在采血后5 min和回输前5m in的血红蛋白、红细胞压积明显低于麻醉前(P<0.01)和非血液保护组(P<0.05),在此期间动脉氧饱和度、心率、平均动脉压均保持稳定状态;非血液保护组在输血前5 m in、输血后5 min及术毕时的血红蛋白、红细胞压积明显低于麻醉前,高于血液保护组。结论颅脑外科手术在麻醉后采集患者自体血安全可行,术中可减少库血输入量70%左右,达到半数以上手术患者不输库血。

Application and nursing of blood protection technique in craniocerebral operation

Objective To explore the method and nursing features of blood protection technique in craniocerebral operation. Methods Fifty-eight patients undergoing major or moderate craniocerebral operation were selected in this study. The patients were divided into two groups according to whether the operation date was odd number or not, 29 patients for each group. In the experimental group with patients who underwent operation on the even date, venous transfusing of equilibrium and gelatin liquid was performed after anesthetizing, and at the same time, auto-bloodletting (10~15 ml/kg) was performed under aseptic manipulation. Hb, Hct, SpO2, urinary output, and the quantity of blood transfusion were recorded at the following time points: before anesthesia, 5 minutes before bloodletting, 5 minutes after bloodletting, 5 minutes before blood retransfusion, 5 minutes after retransfusion, and at the end of operation. Results In the experimental group, the Hb and Hct at the time points after bloodletting and 5 minutes before blood retransfusion were significantly lower than that at the time point before anesthesia (P<0.01), and they were comparatively lower than that in the control group (P<0.05); the MAP, HR and SpO2 were all stable during the experimental process. In the control group, the Hb and Hct at the time points before transfusion, after blood transfusion and at the end of operation were comparatively lower than that at the time point before anesthesia, but they were comparatively higher than that in the experimental group. Conclusion It is safe and feasible to apply auto-bloodletting after anesthesia in craniocerebral operation. The technique of blood protection can reduce the quantity of banked blood transfusion by around 70%, and more than half of the patients can avoid transfusion of banked blood.