单采自体输血在外科手术中的临床应用研究

摘要

Objective To explore the apheresis application of predeposit auotransfusion in surgical operation. Method According to international predeposit auotransfusion standard, 8 ASA Ⅰ~ Ⅱ patients with a greater estimated blood loss were selected. The blood sample ( Red Blood Cell 3 ~6U, Apheresis Platelets 1U) was collected by the blood cell separator at sepluce or diet tert( total volume, 500 ~ 800ml). The patients were rapidly intravenously infused 0.9% NaCl solution (500 ~ 1000ml) while apheresis. Auotransfusion was started when large volumes of blood loss occurred and systolic blood pressure (SBP) fell to below 90mmHg and completed before the end of operation. Allogeneic blood transfusion was performed when autotransfusion could not meet the requirement of blood transfusion. Hemoglobin ( Hb ), hematocrit ( Hct) and platelet count (PLT) were detected before and after predeposit blood collection by the blood cell separator, before and after operation. Result 8 patients received autotransfusion but no one received allogeneic blood transfusion. The levels of Hb, Hct and PLT after predeposit blood collection and after operation were lower than those before predeposit blood collection. The range the blood loss was 300 ~ 1200ml, accounting for 7% ~ 26.49% of total blood volume. The infused solution volume was 1500 ~ 3000ml at the end of operation. The levels of SPB, DPB, HR at the end of operation were normal. Conclusion Apheresis application of predeposit auotransfusion is safe and effective in surgical operation, for the more, predeposit blood collection by the blood cell separator can ensure auotransfusion when excessive blood loss occurs during operation.%目的 探讨术前单采自体血液在外科手术中的临床应用.方法 选择ASA Ⅰ～Ⅱ级,估计术中出血量较大,符合国内外预存自体输血标准的外科择期手术患者8例,入院后第2、3天下午采用血细胞分离机单采,单采压积红细胞3～6U(来源于800 ～ 1200ml静脉全血的红细胞)和机采血小板1U,采集中补充生理盐水500 ～ 1000ml.当患者术中出血较多,患者收缩压下降至90mmHg以下时,开始回输自体血液,并于手术结束前全部回输入患者体内.观察8例患者预存采血前、单采后、手术前、手术结束后血常规[血红蛋白(Hb)、血细胞比容(Hct)、血小板计数(PLT)],手术结束时血压(SPB,DPB)、心率(HR)及手术中液体输入总量、术中出血量、自体输血量、异体输血、输血反应等情况.结果 8例患者术中输注自体血液,未输注异体血液成分,单采中和输血后均无明显不良反应.单采储血后和手术后的血红蛋白、血细胞比容、血小板计数明显低于自体储血前,手术失血量300 ～ 1200ml,占整体血容量的7％～ 26.49％.术后患者心率、血压平稳.结论 通过血细胞分离机单采血液成分进行自体备血安全且疗效较好,能保障中型及大型手术的手术用血.