52例大血管手术中的自体血液回收应用分析

Application of intra-operative cell salvage for great vessels surgery in 52 cases

目的探讨自体血液回收(ICS)技术在大血管外科手术中的应用效果。方法回顾性分析2011年52例大血管病外科手术。自体血液回收(ICS)技术在大血管外科手术中的应用,其中Stanford A型夹层动脉瘤17例,Marfan综合征10例,升主动脉瘤15例,腹主动脉瘤6例,先天性主动脉缩窄或主动脉弓离断4例。所有患者术中全程使用ICS系统,记录回收术中失血量及洗涤红细胞(WRBC)量,随机检测WRBC与库存悬浮红细胞(BRBC)的血气及活化凝血时间(ACT),统计各类患者围术期用血量并与2010年同类病例进行比较。结果全组病例回收术中失血、渗血612～10 058 mL,平均3 199 mL,获得WRBC 130～1 645 mL,平均647 mL;各类大血管患者回收失血量、WRBC量比较相差不显著(P>0.05);WRBC与BRBC血气比较相差显著(P<0.01),ACT值无统计学差异(P>0.05);与2010年同类患者相比较减少40%异体血输入量(P<0.05)。结论大血管外科手术中应用ICS系统具有良好的临床效果,是节约用血、减少库血输入的可靠方法,可常规使用。

Objective To explore the application of intra-operative cell salvage（ICS） for great vessels surgery. Methods The equip- ment of ICS was used for great vessels operation in 52 cases （ from January 2011 to December 2011 ） which included 17 cases with Stanford type A aortic dissection, 10 cases with Marfan＇ s syndrome, 15 cases with ascending aortic aneurysm,6 cases with abdominal aortic aneurysm and 4 cases with aortic coarctation or interrupted aortic arch. The total volume of blood loss and washed red blood cell （WRBC） and all blood transfusion perioperative were recorded ,then blood gas and activated coagulation time （ACT） for WRBC and banked red blood cell （BRBC） randomly were tested. Results Total volume of blood loss was 612 - 10 058 mL,3 199 mL in average and the volume of WRBC was 130 1 645 mL,647 mL in average. The volume of blood loss and WRBC in 5 groups were comparative（ P 〉 0.05 ）, ACT of WRBC and BRBC had no significant difference（ P 〉 0.05 ） , but there were significant differences in blood gas between WRBC and BRBC （ P 〈 0.01 ）. To compare with the similar groups of great vessels surgery patients in 2010,it can reduce 40% BRBC transfusion （ P 〈 0.05 ） perioperative. Conclusion The application of ICS for great vessels surgery has a satisfactory clinical efficacy. Meanwhile it may decrease the need for homologous banked blood transfusion, so it should be used for great vessels surgery in routine.