心脏直视手术后心包及纵隔引流血的分析（附18例报告）

Analysis of Shed Mediastinal Blood After Cardiac Surgery

目的：为心脏直视手术后回输未经洗涤的心包及纵隔引流血提供可靠依据。方法：对１８例心脏直视手术后心包及纵隔引流血和１１例库血进行检测，并对各项结果进行Ｆ检验。结果：术后４小时及６小时心包及纵隔引流血分别占术后２４小时引流血量的５０．７％（３６０±９５ｍｌ）及５７．７％（４３０±１００ｍｌ）。心脏手术后病人血及其引流血经需氧菌及厌氧菌培养均阴性。引流血红细胞压积０．３１，库血０．３４（Ｐ＞０．０５）。引流血纤维蛋白降解产物（ＦＤＰ）２３１μｇ／ｍｌ，库血１２５０μｇ／ｍｌ（Ｐ＜０．０５），说明引流血的纤溶活性明显低于库血。ＶＩＩ因子测定，引流血虽较正常值低，但较库血略高。引流血中游离血红蛋白明显高于库血，分别为１３３８±４０６ｍｇ／Ｌ及２１８±８７ｍｇ／Ｌ（Ｐ＜０．０５）。结论：心脏直视手术后的纵隔及心包引流血回输是安全的。

Objective:This study was designed to evaluate the safety of shed mediastinal blood after cardiac surgical procedures for autotransfusion. Methods:Shed mediastinal blood of 18 cases collected after open heart operations and bank blood from 11 donors were studied.The blood and shed mediastinal blood of 18 patients were cultured for 4 and 6 h.after operation,HCT,FDP,factor VIII and free hemoglobin of the latter and bank blood were analyzed.Differences between the shed mediastinal blood and bank blood were tested for statistical significance by F test. Results:Postoperative mediastinal blood drainage volumes were 50.7%(360±95 ml) and 57.7%(430±100 ml)of the total 24 h drainage volumes at 4 and 6 h,respectively.Anaerobic and aerobic cultures of the shed mediastinal blood were negative.Comparison of shed mediatinal blood of 18 cases with bank blood from 11 donors showed:HCT 0.31 vs.0.34,( p >0.05);FDP 231 μg/ml vs.1 250 μg/ml( p< 0.05);free hemoglobin 1 338 mg/L vs.218 mg/L( p <0.05). Conclusion:It is suggested that shed mediastinal blood could be autotransfused to patients safely.