回输洗涤自体血对机体凝血参数的影响

目的　观察回输洗涤自体血前后机体凝血参数的变化 ,了解自体血液回输技术对其的影响。方法　 2 0例择期心脏手术患者随机分为两组 ,实验组 10例 ,术后回输经洗涤处理的自体血 ;对照组 10例 ,未接受洗涤自体血。分别于术前、体外循环结束后回输自体血液前 15min、回输后 10min、以及体外循环结束后 3h、 2 4h测定激活的部分凝血酶原时间 (APTT)、凝血酶原时间 (PT)、纤维蛋白原 (Fbg)水平。结果　各时间点APTT、PT、Fbg水平 ,两组变化趋势相似。体外循环结束后 ,APTT、PT明显延长 (P <0 0 5 ) ,术后 2 4小时恢复正常 ;纤维蛋白原水平在体外循环结束后明显降低 (P <0 0 1) ,术后 2 4小时内逐渐恢复甚至高于术前水平。但两组同一时间点APTT、PT、Fbg的变化 ,无统计学差异 ;实验组洗涤自体血回输前后APTT、PT、Fbg无明显变化。实验组术后 2 4小时库血用量明显少于对照组 (P <0 0 1) ;两组术后 2 4h胸腔引流量无显著性差异。结论　洗涤自体血回输对机体凝血功能无明显不良影响 ,能明显减少库血用量 ,是一种有效的血液保护措施。

Effect of Autotransfusion on Coagulation Parameters

Objective This study was to determine the effect of autotransfusion on coagulation parameters in cardiac surgery.Method 20 patients, who were to undergo cardiac surgery with cardiopulmonary bypass(CPB), were selected randomly for this study. They were randomly divided into two groups:10 patients in experiment group were to receive autologous blood processed with ZITI 2000 Cell Saver after termination of CPB, and the other 10 patients in control group were not to receive autologous transfusion at the same point. Blood samples were taken before operation (5min before induction of anesthesia), at termination of CPB and before autologous transfusion, at 10min after autologous blood trasfusion, and at 3 hours and 24 hours after termination of CPB. Coagulation parameters, including activated partial thromboplastin time(APTT), prothrombin time(PT) and fibrinogen(Fbg) level, were measured. The quantity of banked blood for transfusion and postoperation chest drainage were recorded and compared.Result In the two groups, similar trends of dynamic change were observed for APTT, PT and fibrinogen level during all the times of measurement. After the termination of CPB, APTT and PT increased significantly(P<0 05), and then gradually decreased to the normal levels after 24 hours; Fbg decreased significantly(P<0 01), then gradually increased to some higher level than that of preoperation after 24 hours. However, there was no statistical differences between the two groups at the same time of measurement by analyzing the levels of APTT, PT and fibrinogen. There was no significant differences in the quantities of postoperation chest drainage between two groups, but less banked blood for transfusion was observed in experiment group (P<0 01).Conclusion Autotransfusion using ZITI Cell Saver has no significant adverse effect on coagulation parameters and can significantly reduce banked blood for transfusion. Autotransfusion was one of the safe and efficient ways to save blood.