急性等容稀释联合血液回收自体输血在RH(D)阴性稀有血型患者外科手术的应用

目的探讨急性等容稀释(ANH)联合术中血液回收自体输血在RH(D)阴性稀有血型患者行外科手术的安全性和可行性。方法选择行外科手术RH(D)阴性稀有血型患者20例,全身麻醉后行急性等容稀释联合术中血液回收。观察患者术前(T0)、血液稀释后(T1)、输自体血前(T2)、输回收血后(T3)、输术前采集的全血后(T4)5个时点的HBG、HCT、PLT、APTT、PT和FIB的变化并进行比较。记录ANH时采血量、回收洗涤红细胞量。结果全部手术患者ANH时采血量平均为(590.00±137.27)ml,术中回收洗涤红细胞量平均(562.50±179.09)ml,输异体血0ml;不同时点的HBG、HCT、PLT、APTT、PT、FIB比较差异有统计学意义(P<0.01)。APTT、PT在T1与T0比较差异无统计学意义(P>0.05),而T2与T0、T3与T2、T4与T3之间比较差异有统计学意义(P<0.01),但仍在正常对照值范围内。HBG、HCT、PLT和FIB在T1与T0、T2与T0、T3与T2、T4与T3之间比较差异有统计学意义(P<0.01)。结论采用急性等容稀释联合血液回收自体输血可节约血液资源,避免输异体血,解决RH(D)阴性血源稀缺难题,可安全用于RH(D)阴性稀有血型外科手术患者。

Applications of acute normovolemic hemodilution combined with autologous transfusion salvage in the surgery for patients with RH(D) negative rare blood type

Objective To explore the security and feasibility of application of acute normovolemic hemodilution(ANH) combined with autologous transfusion salvage in the surgery for patients with RH(D) negative rare blood type. Methods 20 patients with RH(D) negative rare blood type for surgery were given ANH combined with autologous transfusion salvage after general anesthesia.Then,changes of HBG,HCT,PLT,APTT,PT and FIB in the preoperative(T0),posthemodilution time(T1),before blood transfusion(T2),after autologous transfusion(T3),and after collection of whole blood transfusion(T4) of all patients were observed and compared.In addition,the volume of blood collection in ANH and the volume of red blood cells recycle and washed were recorded. Results The average volume of blood collection for ANH of all patients was(590.00±137.27)ml.The intraoperative average volume of recycling washed red blood cells was(562.50±179.09) ml and 0 ml of allogeneic blood was transfused.There were statistical differences in different periods of HBG,HCT,PLT,APTT,PT and FIB(P<0.01).No significant statistical difference was found in the comparison of APTT,PT between T0 and T1(P>0.05),while it was found between T2 andT0,T3 and T2,T4 and T3(P<0.01).But the differences were still within the range of the normal reference value.There was statistically significant difference in the comparison of HBG,HCT,PLT,FIB between T0 and T1,T2 and T0,T3 and T2,and T4 and T3(P<0.01). Conclusion The application of acute normovolemic hemodilution combined with intraoperative autologous transfusion salvage can save blood resource,avoid allogeneic transfusion and solve the problem of scarcity of RH negative blood source.It can be safely applied in surgeries for patients with RH(D) negative rare blood type.