冠状动脉旁路移植术中出血回收方式对血液保护的影响

目的本研究探索将术野出血用自体血液回收机洗涤后再回输的综合血液保护效果和临床性能/价格评价。方法 31例体外循环下冠状动脉旁路移植术患者随机分为2组:研究组(n=16)将全部术野出血用自体血液回收机离心洗涤后再回输,对照组(n=15)将肝素化后的术野出血直接吸回体外循环系统。在体外循前、鱼精蛋白中和后及术后等时间点观察两组患者的血浆游离血红蛋白(FHb)、红细胞及血小板数、肿瘤坏死因子α(TNF-α)、凝血功能指标、肺换气功能指标、术后24小时出血量和输血量、ICU停留时间及ICU费用。结果鱼精蛋白中和后的FHb在研究组明显低于对照组(P0.05),TNF-α术后18 h与体外循环前比较为研究组较对照组低(P0.05),研究组有一例二次开胸止血。其余指标组间无明显差异。结论在本研究设定条件下,将术野内的出血洗涤可有效的降低FHb和术后的血浆TNF-α水平,但对凝血功能及呼吸功能的影响不显著,未减少术后出血量、输血量和ICU停留时间及费用。

The effects of cardiotomy blood processing on blood preservation during on-pump coronary artery bypass grafting surgery

OBJECTIVE During on-pump coronary artery bypass grafting surgery（CAGB）,cardiotomy blood is usually recycled by the means of cardiotomy suction which is a major source of blood activation and damage.The purpose of present study was to evaluate the effect of processing of this blood by a cell-saver on blood preservation and its cost-effectiveness.METHODS 31 patients underwent CABG under cardiopulmonary bypass（CPB） were randomly divided into 2 groups.All cardiotomy blood was processed by a cell-saver during the surgery in the study group（n=16）.While in the control group（n=15）,caridotomy blood was collected into the CPB reservoir by cardiotomy suction after ACT value reached 400 sec and before protamine administration.Plasma free hemoglobin（FHb）,red blood cell and platelet count,tumor necrosis factor-α（TNF-α）,coagulation and respiratory function indicators were measured before CPB,after protamine administration and at certain postoperative time points.Blood loss and transfusion during the first 24 hours after surgery,intensive care unit（ICU） stay time and ICU costs were also recorded.RESULTS The FHb level after CPB was significantly lower in study group compared with control group（P〈0.05）.The ratio of TNF-α value at 18 hours after surgery to that before CPB was significantly lower in study group than in control group（P〈0.05）.One case in study group was reexplored for bleeding.Other values showed no significant differences between groups.CONCLUSION In the present study,processing of cardiotomy blood by a cell-saver was able to decrease FHb and TNF-α effectively,but had insignificant influences on coagulation and respiratory function.Blood loss,blood transfusion,ICU stay time and ICU costs were not affected by the processing.