不同自体输血方式的临床效果研究

目的 探讨不同自体输血方式的有效性,促进医疗机构开展自体输血工作,保障临床输血安全.方法 采用简单随机抽样法随机选择2014年1月至2016年7月,于北京军区总医院或大连中心医院行骨科手术的88例自体输血患者作为研究对象.采用简单随机分组法,将其随机分为,术中自体红细胞回输组(n=43),储存式自体全血回输组(n=25)及储存式自体单采红细胞回输组(n=20).采用简单随机抽样法,选择同期42例于受试者收集医院行骨科手术,并且术中仅接受异体输血的患者,纳入对照组(n=42).记录并分析采血前/术前、输血后当天、输血后第4天,各组患者红细胞计数、血红蛋白(Hb)水平、血细胞比容(HCT)、血小板计数,以及患者住院天数、术中出血量、异体输血量等指标.采用统计学方法比较4组患者上述各项指标的差异.结果 ①本研究4组患者采血前/术前的红细胞计数、Hb水平、HCT、血小板计数分别比较,差异均无统计学意义(P＞0.05).②输血后当天:4组患者的红细胞计数、Hb水平、HCT分别比较,差异均无统计学意义(P＞0.05);4组患者的血小板计数比较,差异有统计学意义(F=4.157,P=0.008).其中,储存式自体全血回输组患者的血小板计数最高[(196.0±43.8)×109/L],高于术中自体红细胞回输组、对照组,并且差异均有统计学意义(P=0.004、0.009);但是,与储存式自体单采红细胞回输组比较,差异无统计学意义(P=0.653).③输血后第4天:4组患者的红细胞计数比较,差异无统计学意义(P＞0.05);4组患者的Hb水平比较,差异有统计学意义(F=3.764,P=0.013).其中,术中自体红细胞回输组的Hb水平最高[(115.6±23.8)g/L],高于储存式自体全血回输组及对照组,并且差异均有统计学意义(P=0.022、0.006);但是,与储存式自体单采红细胞回输组比较,差异无统计学意义(P=0.878).4组患者的HCT比较,差异有统计学意义(F=3.915,P=0.011).其中,储存式自体单采红细胞回输组HCT最高[(34.4=4.8)％],高于对照组,并且差异有统计学意义(P=0.012);但是,与储存式自体全血回输组及术中自体红细胞回输组分别比较,差异均无统计学意义(P=0.059、0.819).④4组患者术中出血量和异体输血量分别比较,差异均无统计学意义(P＞0.05).4组患者住院天数比较,差异有统计学意义(x2=11.990,P=0.007).其中,对照组患者的住院天数最长[14.5 d(9.5～16.0 d)],长于储存式自体全血回输组,并且差异有统计学意义(P=0.007);但是,与储存式自体单采红细胞回输注及术中自体红细胞回输组分别比较,差异均无统计学意义(P=0.09、0.944).结论 临床择期外科手术患者的自体输血方式,首选储存式自体单采红细胞回输,其次为储存式自体全血回输和术中自体红细胞回输.在不能达到自体输血要求时,可选择异体输血.临床医师需要转变观念,逐步降低异体输血率,广泛、有效地开展自体输血工作,进一步保障临床输血安全.

Clinical effects among different strategies of autologous blood transfusion

Objective To investigate effectiveness of different strategies of autologous blood transfusion,in order to promote development of autologous blood transfusion in medical institutions,and to ensure the safety of clinical transfusion.Methods From January 2014 to July 2016,a total of 88 patients undcrgoing orthopedic surgery who received autologous blood transfusion in General Hospital of Beijing Military Region or Dalian Municipal Central Hospital,were randomly selected as research objects by simple random sampling method.A simple random grouping method was used to classify the patients into intraoperative salvaged autotransfusion group (n =43),stored autologous whole blood transfusion group (n=25),and stored autologous red blood cells transfusion group (n=20).A total of 42 patients undergoing orthopaedic surgery who received allogeneie blood transfusion were randomly selected from above hospital during the same period by simple random sampling method,and they were included in control group (n=42).The data including patients’ red blood cell count,hemoglobin (Hb) level,hematocrit (HCT) and platelet count were collected and analyzed in different time points which were before blood collection/ surgery,the first day after blood transfusion,the fourth day after blood transfusion.And days of hospitalization,volume of bleeding in the operation,infusion volume of allogeneic blood in each group were also collected and analyzed.Statistical methods were used to compare the differences of the above indexes among 4 groups,Results ① There were no statistically significant differences in red blood cell count,Hb level,HCT,platelet count among patients of 4 groups before blood collection/surgery (P＞0.05).② There were no statistically significant diffcrcnce in rcd blood cell count,Hb level,HCT among patients of 4 groups on the first day after blood transfusion.But there was significant differences in platelet count among 4 groups (F=4.157,P=0.008).And platelet count of patients in stored autologous whole blood transfusion group was the highest,as (196.0±43.80) × 109/L.Among them,compared with control and intraoperative salvaged autotransfusion groups respectively,the differences were statistically significant (P=0.004,0.009).However,compared with stored autologous red blood cells transfusion group,the difference was not statistically significant (P=0.653).③ There was no statistically significant difference in red blood cell count of patients in 4 groups on the fourth days after blood transfusion (P ＞ 0.05).Comparison of Hb level in 4 groups,the difference was statistically significant (F=3.764,P=0.013).Hb level of patients in intraoperative salvaged autotransfusion group was the highest [(115.6 ±23.8) g/L],which compared with stored autologous transfusion and control groups respectively,the differences were statistically significant (P =0.006,0.022),but there was no statistically significant that compared with preoperative autologous red blood cells group (P =0.878).Comparison of HCT in these 4 groups,the difference was statistically significant (F=3.915,P =0.011).The HCT of patients in the stored autologous red blood cells transfusion group was the highest [(34.4 ± 4.8)％] among 4 groups,which compared with control group,the difference was statistically significant (P =0.012);but compared with stored autologous whole blood transfusion and intraoperative salvaged autotransfusion groups respectively,the differences were not statistically significant (P=0.059,0.819).④ There were no statistically differences observed in bleeding volumc and allogeneic blood transfusion volume in the operation among 4 groups (P＞0.05).Hospitalization days were compared,and the difference was statistically significant (x2=11.990,P=0.007).Among them,patients in control group had the highest hospitalization days [14.5 d(9.5 16.0 d)],which compared with stored autologous whole blood transfusion group,the difference was statistically significant (P =0.007);compared with stored autologous red blood cells transfusion and intraoperative salvaged autotransfusion group respectively,the differences were not statistically significant (P =0.09,0.944).Conclusions For the selection of auto logous blood infusion strategies in patients undergoing elective surgery in clinical,preferred to use stored autologous red blood cells transfusion,followed by stored autologous whole blood transfusion and intraopcrative salvaged autotransfusion.When autologous blood transfusion is not available,allogeneic blood transfusion could be uscd.Thercfore,clinicians need to change their ideas to reduce the rate of allogeneic blood transfusion gradually,and to develop the autologous blood transfusion extensively and effectively,so as to ensure the safety of clinical blood transfusion.