心脏瓣膜置换术患者应用改良贮存式自体输血和异体输血的效果比较

目的 对比改良贮存式自体输血和异体输血对心脏外科瓣膜置换术患者手术及术后恢复的影响,确定改良贮存式自体输血采血法在心脏外科手术中应用的效果.方法 选取2013年1～5月本院行心脏瓣膜置换术的择期手术患者200例,其中使用改良贮存式自体输血采血法进行术前自体备血的患者100例,年龄21～73岁,心功能分级Ⅱ～Ⅲ级,采血前平均Hb为（147.34＆#177;12.69） g/L,Hct为（43.41土3.72）％;使用异体血术前备血的患者100例,年龄18～71岁,心功能分级Ⅱ～Ⅲ级,术前平均Hb为（133.93＆#177;25.94） g/L,Hct为（38.24＆#177;9.41）％,对比两组患者在围术期各项指标的差异.结果 100例改良贮存式自体输血组使用血液总量319U,100例输注异体血组使用血液655U,两者相比,自体输血组手术血液使用总量、平均异体红细胞量、平均异体血浆量均明显降低（P＜0.05）.自体输血组采血后血红蛋白浓度、红细胞压积轻度降低,但在正常范围内.术后1d血红蛋白浓度及红细胞压积均明显高于异体输血组患者,差异具有统计学意义（P＜0.05）.出院前血红蛋白浓度、红细胞压积两组患者比较差异不明显;自体输血组患者术后到出院的平均时间为（6.58＆#177;1.9）d,异体输血组患者为（10.01＆#177;3.87）d,差异有统计学意义（P＜0.05）.使用改良贮存式自体输血的患者术后未发生感染,而异体输血组患者术后感染率为3％.同时自体输血组患者的住院成本明显降低（P＜0.05）.结论 改良贮存式自体输血采血法,较异体输血法对红细胞破坏少,血液输注量少,患者术后各项指标恢复快,感染率低,经济实用,可广泛应用于心脏外科瓣膜病等择期手术.

A Comparison of Improved Preoperative Autologous Deposit with Allogeneic Blood Transfusions in Patients with Valve Replacement Surgery

Objective To investigate the effects of autologous and allogeneic blood transfusions on the patients with valve replacement surgery, and to study the feasibility of using the optimized blood collection scheme in patients with car- diovascular surgery. Methods Two hundreds patients who underwent valve replacement surgery between were selected in 2013. The first group included 100 patients with heart function grade Ⅱ-Ⅲ, and age between 21~73 years. The im- proved blood collection scheme was adopted for autologous blood pre-deposit. The second group comprised of 100 patients who underwent allogeneic blood transfusions with heart function grade Ⅱ-Ⅲ , and age between 18~71 years. Results One hundred of patients with autologous blood were given a transfusion of 319 U in total, and the other 100 patients of al- logeneie blood were given 655 U. There was significant difference between the two groups. Values of Hb and Hct were sig- nificantly decreased after autologous blood collected （P〈0.05） but within the normal scope. Hb and Hct values of autolo- gous blood transfusions were significantly higher than those of allogeneic blood transfusions after surgery（P〈0. 05）. No statistical difference of Hb and Hct values was noted between the two groups on their being discharged from the hospital （P〉0. 05）, the mean hospitalization days, however, of the autologous blood group were significantly reduced by 3.5 days compared to that of the allogeneic blood group （P〈0.05）. None of the 100 cases of autologous blood group got infection af- ter operation, but 3 of 100 cases of allogeneic blood group got infected after operation. Conclusion Patients with valve replacement surgery might benefit from the improved preoperative autologous deposit due to the decreased blood transfu- sion, low infections and short time of hospitalization.