急性血液稀释自体输血在颅脑手术中的应用

Clinical study on application of acute dilute autotransfusion in patients undergoing craniocerebral operation

目的:评价急性血液稀释自身输血应用于颅脑手术患者的安全性和可行性。方法:142例无内科合并症的颅脑手术患者随机分为同种异体输血组(对照组71例)及自身输血组(治疗组,71例),治疗组麻醉后采血至150ml时快速静脉滴注采血量2倍量的稀释液,输液毕立即手术,治疗组患者在手术临近结束或出血超过300ml时回输自体血;对照组在出血超过300ml时输同种异体血。观察生命体征及测定输血前及术后24h红细胞(RBC)、血红蛋白(HGB)、血小板(Plt)、血球比积(Hct)、网织红细胞、血红细胞沉降率(ESR)、纤维蛋白原(Fb)、凝血酶原时间(PT)、部分凝血活酶时间(APTT)、血黏度、血浆电解质(K+、Na+、Cl-)、动脉氧分压(PaO2)、动脉血氧饱和度(SaO2)及C反应蛋白(CRP)。结果采血及回输血过程无不良反应,生命体征监测参数稳定,对照组及治疗组在麻醉前、术后24h及术后24两组间血压、心率、RBC、HGB、Plt、Hct、Fb、PT、APTT、网织红细胞、血黏度、血电解质(K+、Na+、Cl-)、PaO2及SpO2变化无统计学意义(P>0.05),对照组及治疗组术后24h ESR及CRP均比输血前升高(P<0.01),对照组术后24hESR及CRP比治疗组显著升高(P<0.01)。结论:急性血液稀释自身输血应用于颅脑手术安全、可行,可降低颅脑手术病人对同种异体血的需求,且急性血液稀释自身输血比同种异体输血炎症反应轻。

Objective To evaluate the applicability and security of acute dilute autotransfusion in patients undergoing craniocerebral operation.Method One hundred and forty-two patients underwent craniocerebral operation without complication of internal medicine were randomly divided into two groups：variant blood transfusion of the same race group（the control group,n=71） and acute dilute autotransfusion group（the treated group,n=71）.After anesthesia,the two times amount of Ringer′s solution and HAES-Steril infusion was infused since the 150ml blood was collected before operation in the treated group. The operation beganafter the transfusion. Autotransfusion began before the operation finished or when blood loss exceeded 300ml in the treated group. Variant blood transfusion of the same race began when blood loss exceeded 300ml in the control group. The vital sign was observed during blood was Collected and diluted. The red blood cell,hemoglobin, platelet, haematocrit, reticulocyte ,;blood sedimentation rate, fibrinogen, blood viscosity, blood electrolyte （ potassium, natrium and chlorine）, arterial oxygen pressure, arterial oxygen saturation and C -reactive protein were measured before anesthesia and twenty -four hours after operation. Results The red blood cell, hemoglobin, platelet, haematoerit, retieulocyte, fibrinogen, blood viscosity, blood electrolyte （ potassium, natrium and chlorine） , arterial oxygen pressure and arterial oxygen saturation did not changed significantly （ P 〉 0.05 ） between before anesthesia and twenty - four hours after operation, and furthermore these items did not changedI significantly between the two groups twenty - four hours after operation. The blood sedimentation rate and C - reactive protein were higher twenty - four hours after operation than before anesthesia in the two groups, and the blood sedimentation rate and C - reactive protein in the control group greatly increased than the treated group. Conclusion Acute dilute autotransfusion is applicable and secure in patients undergoing craniocerebral operation. It can reduce the need of variant blood transfusion of the same race in patients undergoing craniocerebral operation. Reactive inflammation in acute dilute autotransfusion is less than variant blood transfusion of the same race.