自体血液回收对骨科手术患者血液氧合和乳酸代谢的影响

Effect of blood salvage on oxygenation and blood lactic acid metabolism in orthopedic surgery

目的观察自体血液回收对骨科手术患者血液氧合和乳酸代谢的影响。方法 40例择期行骨科手术患者,ASA分级Ⅱ级,采用随机数字表法分为两组:回收组和对照组,每组20例。回收组术中应用血细胞回输仪进行血液收集、回输,分别记录两组病人术前、术毕及术后24 h动脉血氧分压(PaO2)、混合静脉血氧分压(PvO2)、动脉血氧饱和度(SaO2)、混合静脉血氧饱和度(SvO2)、氧摄取率(ERO2)以及动、静脉血乳酸(LacA、LacV)的变化。记录患者术中回收血量,异体浓缩红细胞量及血浆用量。结果手术开始至术后24h内回收组输注异体浓缩红细胞量及血浆用量较对照组明显减少(P<0.05);回收组术毕PaO2、PvO2、SvO2均高于对照组(P<0.05);与对照组比较,回收组术毕及术后24 h ERO2以及LacA、LacV含量均降低(P<0.05)。结论骨科手术患者应用自体血液回输技术能及时回收失血,维持有效循环,明显改善血液氧合和能量代谢。

Objective To evaluate the effect of blood salvage on oxygenation and blood lactic acid metabolism in orthopedic surgery. Methods Forty patients with ASA Ⅱ underwent orthopedic surgery who aged 30~65 years were randomly divided into two groups（n=20 each）.Salvage group received autologous blood transfusion by autotransfusion apparatus.The blood samples were collected before operation,immediately after operation and 24h after operation,for the measurement of PaO2,PvO2,SaO2,SvO2,ERO2 and blood lactate concentration.The volume of blood recovery,erythrocyte suspension and plasma were counted. Results The volume of erythrocyte suspension and plasma were significant higher in control group than in salvage group from operation began to post-operation（P0.05）.The PaO2,PvO2,SvO2 were significant higher in salvage group than in control group at immediately after operation（P0.05）.Compared with control group,the LacA,LacV and ERO2decreased significantly in salvage group（P0.05）. Conclusion Autologous blood transfusion can effectively salvage autologous blood in time,maintain hemodynamic stability and has a great effect on the oxygen supply and demand and metabolism of energy.