术中5835输血方案临床应用研究

Clinical study on the 5835 transfusion scheme during operation

目的探讨手术中应用自拟'5835'输血方案降低异体输血量的可行性与临床意义.方法术前ASA Ⅰ～Ⅱ级,择期行消化系统癌根治手术患者120例,以术中输血方案不同分3组:A组传统输血方案组;B组卫生部输血指南方案组;C组自行设计'5835'输血方案组,每组均观察40例.应用金科威UT4000F多功能监测仪持续监测NIBP、SpO2、ECG等指标,记录术中出血量、输血量,并分别于术前24 h、术中输血前、术后24 h测定血红蛋白(HGB)和红细胞压积(HCT).结果 (1)三组术中出血量相近,差异无显著性(P＞0.05);输血量分别为(197±57)ml、(91±35)ml和(99±42)ml,A组与B或C两组对比差异均非常显著(P＜0.01);而B与C组间对比虽然C组数值大于B组,但差异无显著性(P＞0.05).(2)Hb与HCT组内不同时段对比差异均有显著性(P＜0.01或P＜0.05);组间对比术前差异无显著性;输血前A组显著高于B、C组(P＜0.05);C组高于B组,但差异无显著性(P＞0.05).结论手术期间应用5835输血方案可最大限度地落实卫生部<临床输血技术规范>关于'手术创伤输血指南'确定的输血标准,具有简便实用、易操作、易推广应用的优点.

Objective To investigate the feasibility and significance in decreasing the amount of transfusion by using the serf-designed 5835 transfusion scheme during operation. Methods 120 patients with digestive carcinoma（ASAⅠ～Ⅱ before operation） were divided into three groups according to double blind random rule,40 cases in each group. Group A： traditional transfusion scheme, group B： transfusion scheme issued by the Ministry of Health,group C ： self-designed 5835 transfusion scheme. The HGB and HCT were detected 24 hours before operation, during operation and 24 hours after operation. During operation NIBP, SpO2 and ECG were observed by UT4000F-monitor, and the amount of bleeding and transfusion was also recorded. Results There was no significant difference in the amount of bleeding among three groups （ P〉0.05 ）, however, there was a signiticant difference in the mean amount of transfusion between group A and group B, C, which was （196.7±56.9）ml in group A, （91.2±34.6）ml in group B and （98.8±41.7）ml in group C.Although the mean amount of transfusion in group C was higher than that in group B,there was no significant difference between two groups（ P〉0.05）.There were significant differences in HGB and HCT at different period in the same group （ P〈0.01 or P〈0.05）,but there was no significant difference among groups （ P〉0.05）. Conclusion The 5835 transfusion scheme is the most proper one to practice the technical specification of clinical transfusion issued by the ministry of health, and it is simple, practicable and easy to be mastered and spread.