自体输血对心脏直视手术围术早期的影响

目的通过对23例心脏直视瓣膜手术成年患采用自体输血的临床观察，并与输异体血患组进行对比．探讨术前血色素正常患进行不输血心脏直视手术对围水早期产生的影响和相应处理方法。方法自体输血组的23例患术中采用综合节血措施．包括术毕回输体外循环前经腔静脉营入的肝素血(15～20ml／kg)，术毕回输洗血球机清洗的手术刨口血血球和全部机血应用抑肽酶等：(1)自身对照比较患术前、术后返ICU及次晨的血红蛋白(Hb)、血小板(PLT)、白蛋白(ALB)、凝血酶原时间(PT)、纤维蛋白原(FIB）及动脉血氧分压(PaO2)的变化。(2)同时选择27例接受输异体血的瓣膜替换术患作为对照，比较两组间中心静脉压、血红蛋白、血小板及术后引流量等差异。结果自体输血组患术后Hb、PLT、AI．B、FIB均较术前降低(P<005)，PT显延长(P<0．05)；但Hh、PLT、FIB、PT仍在正常范围，ALB经补充后也能达到正常下限，Pa02水后较术前显升高。与对照组相比．实验组患术后Hb、PLT、引流量、术后晶体和蛋白输用量并无统计学显差异，而术中失血量、用库血量积术后代血浆用量却有明显差异。结论采用自体输血的心脏直视手术。围术期虽有轻度贫血但不影响血液的携氧功能，术后出凝血状况也不受影响。自体输血的影响主要集中在洗血球机回收刨VA失血同时也造成血浆丢失．加上不可控失血．造成术后围术早期血容量与血中白蛋白的变化，术后需补充适量代血装或人血白蛋白。

Influence of autotransfusion on the early perioperative period of open heart surgery

Objective By observation of twenty-three adult patients undergoing open heart surgery with autotransfu-sion and comparison with homologous blood transfusion group, we analyze the influence of autotransfusion on early periop-erative period and corresponding approaches. Methods Comprehensive measures of blood conservation, including retrans-fusion of heparinized blood collected before CPB, usage of cell saver and aprotinin, were used in autotransfusion group. (1) Hemoglobin( Hb), platelet(PLT), albumin( ALB), prothrombin time(PT), fibrinogen(FIB)and PaO2 were recorded in the time of pre-operation, immediate post-operation and the day after operation respectively. (2)Twenty-seven patients undergoing valve replacement surgery with homologous blood transfusion were chosen as control group and several variances such as post - operative CVP, Hb, PLT, the volume of postoperative drainage were compared statistically between the two groups. Results Although Hb, PLT, ALB and FIB of auto-transfusion group significantly decreased and PT markedly prolonged postoperatively, Hb, PLT, FIB and PT were still in the normal range; PaO2 significantly increased. There were no significant differences between the two groups in postoperative HB, PLT, the volume of drainage and usage of albumin and crystal fluid postoperatively, while the volume of blood loss in operation and usag of bank blood and colloid fluid were significantly different. Conclusion Auto-transfusion in open heart surgery could cause mild anaemia, but doesn't affect the ability of blood to carry oxygen; the condition of coagulation was not influenced as well; the main influence of auto transfusion on patients in the early peri-operative period of open heart surgery was lost volume of albumin and blood by the reason of uncontrolled blood loss in operation and plasma loss by cell saver. As a result, it is necessary to supplement appropriate albumin and colloid fluid postoperatively.