自体血液回输技术在心脏外科手术术中及术后的应用

摘要

目的：前瞻性研究心脏外科手术全程使用自体血液回输技术的可行性，探讨自体血液回输对患者术后全身炎性反应的影响。方法选择2013年1月至2015年1月于本院行择期心脏外科手术的120例患者为研究对象，根据输血方式将其分为对照组（未行自体血液回输，57例）和观察组（全程行自体血液回输，63例）。比较两组患者胸腔引流量、库存血输入量以及手术前后血浆补体终末复合物（sC5b-6）、白细胞介素-6（IL-6）、肿瘤坏死因子-α（TNF-α）水平。结果观察组平均每例患者回收浓缩红细胞937 ml。观察组患者库存血输入量明显少于对照组（P＜0.05），且sC5b-6、IL-6、TNF-α水平与对照组同时间点比较明显下降（P＜0.05）。术后1小时，两组患者血红蛋白（Hb）、血细胞比容（HCT）、血小板计数（PLT）均低于术前（P＜0.05），但术后12、24、48小时，两组患者Hb、HCT、PLT与术前比较无显著差异（P＞0.05）。术后各时间点，两组患者动脉血pH、动脉血氧分压（PaO2）、动脉血氧饱和度（SaO2）、凝血酶原时间（PT）、凝血酶时间（TT）、活化部分凝血活酶时间（APTT）、纤维蛋白原（FIB）水平与术前比较均无显著差异（P＞0.05），且同时点组间比较亦无显著差异（P＞0.05）。结论心脏外科手术可全程使用自体血液回输技术，并可减少库存血输入量，自体血液回输后可以降低部分炎性因子水平，减轻患者体外循环术后的全身炎性反应。%ObjectiveTo investigate the clinical feasibility of autologous blood transfusion in cardiac surgery and explore its influence on systemic inflammatory reaction after surgery.MethodFrom January 2013 to January 2015 in our hospital 120 patients underwent selective cardiac surgery were divided into control group (57 cases) and observation group (63 cases). Observation group patients received autologous blood transfusion while control group patients received non- autologous blood transfusion. Recorded the amount of thoracic cavity drainage and banked blood transfusion volume. Then detected the levels of terminal compound (sC5b-6), interleukin-6 (IL-6) and tumor necrosis factor-α (TNF-α) of both groups.Result Observation group recollected packed red blood cells with a mean value of 937 ml and the dosage of banked blood in observation group was obviously less than control group (P<0.05). The levels of sC5b-6、IL-6, TNF-α were significant lower in observation group compared to control group at the same time point (P<0.05). 1 hour after operation, Hb, HCT and PLT were all lower than preoperative in the two groups (P<0.05), but 12, 24, 48 hours after operation, there were no significant differences in Hb, HCT, PLT between the two groups (P>0.05). At each time point after operation, there were no significant differences in pH, PaO2, SaO2, PT, TT, APTT, FIB levels between the two groups (P>0.05), and there was no significant difference between the two groups at the same time (P>0.05).ConclusionApplying autologous blood transfusion technique in cardiac surgery can alleviate the systemic inflammatory recations of patients after cardiopulmonary bypass and with the additional benefits of less transfusion volume of banked blood.