体外循环术中自体血回收对血液成分及凝血功能的影响

目的观察体外循环术中不同自体血回收方式对患者血液成分及凝血功能的影响。方法随机将60例体外循环下心脏手术的成人患者分为A、B两组，均为30例。A组为观察组，全部术野出血用自体血液回收机离心洗涤后于手术结束前回输体内。B组为对照组，不采用自体血液回收机，将肝素化后的术野出血直接吸回体外循环系统停机前回输体内，鱼精蛋白拮抗后机器余血打入输血袋，于手术结束前静脉回输。对两组患者麻醉前、体外循环中及术毕静脉血进行血常规及凝血四项指标的测定，记录停机后两组激活凝血时间（ACT）及术后24h内胸腔引流量和输注异体血用量，并对以上观察结果进行比较分析。结果①观察组患者术后24h内胸腔引流量及异体血用量明显少于对照组，差异有统计学意义（P〈0．05）。②与术前相比，两组患者血红蛋白（Hb）、红细胞比容（Hct）和血小板（PLT）均明显下降，凝血酶原时间（PT）、活化部分凝血活酶时间（APTT）和凝血酶时间（TT）明显延长，但两组间比较差异无统计学意义。③术毕观察组Hb和Hct值较体外循环中明显回升，且与对照组相比差异有统计学意义，但仍略低于术前。④两组术毕PLT、PT、APTT和TT均明显低于术前，但仍在正常范围内，两组间差异无统计学意义。结论体外循环期间自体血回收对患者血液成分及凝血功能的影响不明显，是一种有效的血液保护方法。

Influence of blood autotransfused from cardiopulmonary bypass circuit on blood constituent and blood coagulation function

Objective To observe the influence of blood autotransfused from cardiopulmonary bypass circuit on blood constituent and blood coagulation function. Methods Sixty cases of adult cardiac surgery patients undergone CPB were randomly divided into two groups （A, B, n=30 respectively）. In observation group A, all of the surgery field bleeding was collected, centrifuged and washing with autologous blood recover machine and then autotransfused before the end of surgery. In control group B, the operative field heparinized bleeding was directly sucked into the cardiopulmonary bypass system and the heprin was neutralized by protamine before the CPB machined halt, the remaining blood of machine was transfused back into body before the end of surgery. Venous blood for determination of routine blood and coagulation function was collected in two groups of patients before anesthesia, during CPB and end of surgery,. The activated clotting time （ACT） after downtime, chest drainage within 24 h and transfusion of allogeneic blood dosage postoperation were compared between the two group. Results （1）24 h chest drainage flow and the amount of aUogeneic blood were significantly less than the control group （P〈 0.05）. （2）Compared with pre-operation, the hemoglobin （Hb）, hematocrit （Hct） and platelet （Pit） were significantly decreased, prothrombin time （PT）, activated partial thromboplastin enzyme time （APTT） and thrombin time （TT） were significantly longer, but there were no significant differences between two groups. （3）The recovery speed of Hb and Hct after surgery was significantly higher in A group compared with the control group, but still slightly lower than before surgery. （4）The PLT, PT, APTT and TT postoperation were significantly lower than preoperation, but the difference between the two groups has no statistically significant. Conclusion Blood autotransfused during CPB has no obvious effect on blood components and coagulation function.