回收式自体输血150例分析.DOCVIP

临床医学论文-回收式自体输血150例分析 【摘要】? 目的 总结回收式自体输血的经验，探讨回收式自体输血的安全回输血量、时间和注意事项。方法 将回收血与抗凝剂混匀后用8层湿盐水纱布过滤，确定无污染后用60 μm滤网的输血器回输150例。其中外伤性血胸15例，外伤性血腹135例。回输血量单例次350～2 500 ml，总回输血量157 500 ml。结果 149例回输安全。其中128例未追加异体输血（85.9%）；21例追加异体输血（14.1%）。1例于术后36 h因DIC和MODS死亡，死亡率为0.67%。结论 回收式自体输血适宜于术中，尤其严重外伤性血胸、血腹在抢救性手术过程中因异体血源困难时。自体血回输将有效扼制病情，挽救生命，且费用少，避免了异体输血的诸多不良反应，是一种安全有效的输血方法。 【关键词】? 回收式 自体输血 ??? Analysis on reuse autohemotransfusion of 150 cases ??? ［Abstract］? Objective? To summarize reuse autohemotransfusion experience on the safety of blood transfusions，time and attention to the matter.Methods? We first mixed blood and anticoagulants，then filtered them with 8 layer wet saline gauze，after determining clean and transfused with 60 μm strainer for 150 cases.These included traumatic hemothorax of 15 cases and traumatic blood abdominal of 135 cases.Single case of transfusion was 350～2500 ml，the total return was 157，500 ml.Results? 149 cases of transfusion was safe.128 cases were without? allogeneic blood transfusion （85.9%）;21 cases were additional blood transfusion （14.1%）.Because of DIC and MODS，one case in postoperative 36 hours died.Mortality rate was 0.67%.Conclusion? The reuse autohemotransfusion is suitable for the operation，particularly severe traumatic hemothorax，abdominal blood in the course of the rescue operation because of allogeneic blood difficulties.Autologous blood transfusion will effectively curb illness,save lives，cost less，and many adverse reactions，so it is a safe and effective blood transfusion method. ??? ［Key words］? reuse；autohemotransfusion ??? 回收式自体输血是外伤性血胸、血腹急症手术中的有效安全措施。我院自1993以来对外伤性血胸、血腹急症手术中应用回收式自体输血150例。效果满意，现报告如下。 ??? 1? 临床资料 ??? 1.1? 一般资料? 本组患者共150例，男138例，女12例。年龄15～56岁。外伤性血胸15例；外伤性血腹135例；其中脾破裂115例，肝破裂14例，肠系膜血管破裂6例。出血（伤后）到回输时间30 min～24 h。每例回输血量350～2 500 ml，平均1 050 ml。总回输血量157 500 ml。 ??? 1.2? 方法? 开胸或开腹后，用无菌不锈钢器皿（杯）将未凝固血液舀入回收储血瓶或不锈钢碗中。按每100 ml加入25%枸橼酸钠250 mg抗凝。回输：用8层湿盐水纱布过滤，腹腔探查确定：（1）无肉眼可见的胆管损伤及胆汁污染；（2）无胰腺挫裂伤及胰液污染；（3）无胃、肠腔破裂或胃、肠壁挫裂伤致血液污染。然后用60 μm滤网的输血器输入。当回输量