零输血在不停跳搭桥术中的临床应用

No-blood-transfusion during off-pump coronary artery bypass grafting procedure

目的探讨不停跳搭桥术（OPCAB）围手术期零输血的可行性。方法分别选择186例OPCAB患者为零输血组，462例OPCAB患者为输血组。比较2组术中出血量、术后引流量、输血量、术后感染率、术后并发症发生率、住院天数等指标。结果2组病例手术中的出血量及术后引流量均无统计学意义（P〉0．05），围手术期中，2组的并发症发生率无统计学意义，但术后的感染率零输血组（0．98±0．30）％明显低于输血组（4．72±1．10）％（P〈0．05），零输血组平均留院（12．1±0．9）d少于输血组的（17．0±1．2）d（P〈0．05）。结论零输血0PCAB是一种安全的手术，而且可以减少感染发生率，缩短留院天数。

Objective To investigate the feasibility of no-blood-transfusion during off-pump coronary artery bypass grafting （OPCAB）. Methods One hundred and sixty-eight patients were enrolled as no-blood-transfusion group, with 462 patients as a control group. Blood loss during operation, postoperative drainage, blood transfusion, complications including infection and postoperative hospitalization were compared between 2 groups. Results There was no statistical difference in blood loss and postoperative drainage between the two group （ P 〉 0. 05 ）. In control group, no transfusion reaction occurred. Complications of arrhythmia, low cardiac output syndrome, respiratory dysfunction, disturbance of electrolytes and acid base balance between the two groups also showed no difference. But infection rate （mainly incision and pectoral cavity infection） in no-blood-transfusion group （0.98 ±0.30）% was lower than blood transfusion group（4.72 ± 1.10） % （P 〈0. 05）. As a result, postoperative hospitalization in no-bloodtransfusion group （ 12.1 ± 0.9） was significantly shorter than control group （ 17.0 ± 1.2 ） （ P 〈 0.05 ）. Conclusion With development of blood protection and coronary artery bypass graft techniques, especially the application of ＂off-pump＂, most of the operations can be done without blood transfusion, also with decreased infection rate and shortened hospital days.