摘要
目的评估自体血液回输用于体外循环(CPB)心脏手术的有效性、安全性和性价比。方法将160例择期行CPB心脏手术的患者,随机分配到自体血液回输组(CS组)和对照组(C组),每组各80例。CS组,手术时非肝素化期间的所有创面及纵隔出血,经抗凝后全部吸入自体血液回输机。CPB结束后的管道剩余血,直接吸入自体血液回输机;C组,手术时非肝素化期间的所有创面及纵隔出血,CPB结束后的管道剩余血,均被丢弃。鱼精蛋白拮抗肝素后5 min至术后24 h,若患者HB<80 g/L,C组予异体RBC输注;CS组先输自体RBC,若在输完后HB仍<80 g/L,予异体RBC输注。术后若出现异常出血,按流程处理。观察CS组术中自体血液回输量及2组围术期异体血液输注情况;观察围术期凝血功能损害及术后不良事件;观察输血相关费用。结果 CS组平均术中回输自体血液497.6 ml;围术期异体RBC输注比例和数量低于C组(P=0.0002,0.0001);手术结束时肝素残留发生率及术后异常出血发生率高于C组(P=0.035,0.039);异体红细胞费用及总异体输血费用低于C组(P=0.0001,0.0007);总输血费用高于C组(P=0.0001)。结论 CS应用于心脏手术,可以降低围术期异体RBC输注比例和数量,不增加术后不良事件总发生率,但可在一定程度上损害凝血功能及增加总输血费用,因而是有效的、安全的和不具有性价比的。
Objective To evaluate the efficacy, safety and cost-effective of autologous blood transfusion in cardiac surgery with cardiopulmonary bypass （CPB）. Methods One hundred and sixty patients scheduled for cardiac surgery with CPB were randomly divided into cell salvage group （Group CS）and control group （Group C）with 80 cases in each group. In Group CS, shed blood from wound and mediastina were sucked into the cell saver reservoir after anti-coagulated by heparin before heparinization. The residual blood in the cannula after weaning from CPB was also sucked into the cell reservoir. In Group C, all the blood was discarded. From 5 min after heparin was neutralized with protamine during surgery to 24 h after surgery,if the HB level was less than 80 g/L,the patients in group C were transfused with allogeneic RBC, while patients in Group CS were first transfused with autogenous blood and followed with allogeneic red blood cell （RBC） transfusions. Postoperative excessive bleeding patients were treated according to the protocol in Figure 1. The volume of autologous blood transfusion in group CS was recorded. The volume of allogeneic RBC transfusions, ratio of perioperative impairment of coagulative function and postoperative adverse events, the costs of transfusion-related were compared between the two groups. Results The mean volume of autologous RBC returned in Group CS was 497.6 ml;The proportion and quantity of allogeneic RBC transfusions were less in Group CS than that in Group C （P = 0. 0002,0. 0001, respectively） ;The pro- portion of impairment of coagulative function at the end of surgery and proportion of postoperative adverse events were higher in Group CS than those in Group C （P = 0. 035 ,0. 039 , respectively） ;The cost for allogeneic RBC and total alloge- neic transfusion were less in Group CS than that in Group C （P = 0. 0001,0.0007, respectively） ;The cost for total transfu- sion was higher in Group CS than that in Group C （ P = 0.0001 ）. Conclusion Cell salvage is effective and safe in cardi- ac surgery which can decrease the proportion and quantity of allogeneic RBC transfusions but not increase the incidence of postoperative adverse events. But its cost-effective is lower because of the higher cost for total transfusion.
出处
《中华全科医学》
2015年第1期9-11,共3页
Chinese Journal of General Practice
基金
浙江省自然科学基金(LY12H08005)
关键词
自体血液回输
心脏手术
心肺转流术
输血
Autologous blood transfusion
Cardiac surgery
Cardiopulmonary bypass
Transfusion
