体外循环手术中自体输血临床探究.docVIP

体外循环手术中自体输血临床探究 　 作者：谭伟 方海宁 吴锋耀 蔡海燕 冯绮云 罗又桥 【摘要】 目的 通过将自体输血等多种节血措施综合应用于体外循环(extracorporeal circulation,ECC)心脏手术,观察不用或少用异体库血进行心脏手术的效果。方法 对30例进行ECC心脏手术患者（实验组）术中采用综合节血措施,包括术前及ECC前采集自体血贮存术后回输、回输剩余机血、术前和术中应用药物保护血液提高凝血功能等。同期选择30例异体输血的心脏手术患者作为对照组,比较两组间血小板(Plt)、血红蛋白(Hb)、红细胞比积（Hct）、异体输血量及术后纵隔引流量等差异。结果 实验组与对照组相比, 术后Plt 、Hb和Hct均无统计学显著性差异(Pgt;0.05),而术后引流量、异体输血量实验组明显少于对照组(P＜0.05)。结论 心脏直视手术采用自体输血等多种综合节血措施,能明显减少手术出血，少输或不输异体血。 【关键词】 自体输血;异体输血;体外循环;心脏手术 　　Perioperative Autohemotransfusion in the Cardiac Operation with Extracorporeal Circulation 　　Abstract: OBJECTIVE To study the effect of perioperative autologous blood transfusion in the cardiac operation with extracorporeal circulation(ECC). METHODS In 30 cases (study group) undergoing the cardiac operation of ECC, comprehensive measures of blood conservation were taken, including autologous blood collected before operation and ECC, retransfusion of blood and protecting blood with drugs during operation. Other 30 cases undergoing the operation with homologous blood transfusion were chosen as control group. Several variances, such as postoperative hemoglobin (Hb), platelet (PLT), hematocrit (Hct), the volume of homologous blood transfusion and the volume of postoperative drainage were compared between the two groups. RESULTS There were no significant differences between the two groups in postoperative Hb, PLT and Hct, but the volume of homologous blood transfusion and postoperative drainage were significantly different. CONCLUSION Comprehensive measures of blood conservation in the cardiac operation, such as autohemotransfusion, can significantly reduce the volume of blood loss during operation and homologous transfusion. 　　Key words： Autohemotransfusion; Homologous transfusion; Extracorporeal circulation; Cardiac operation 　　体外循环(extracorporeal circulation,ECC)心脏直视手术中因大量失血通常需要进行异体输血,而输血伴随的并发症有传染性和免疫性疾病的风险［1-2］。节约用血及少用或不用异体库血是现实要求和发展趋势。自2005年 1月至12月我们采用在自体输血基础上综合其它节血措施，对30例患者进行ECC心脏直视手术,取得良好节血效果。 　　1 资料与方法 　　1.1 临床资料 2005年 1月至12月对