洗涤式自体血回输对心脏手术患者凝血和携氧功能的影响

Effect of Abstergent Autologous Blood Transfusion on Blood Coagulation and the Ability of Blood to Carry Oxygen in Patients Undergoing Cardiac Surgery

目的:观察洗涤式自体血回输对心脏手术患者凝血功能和红细胞携氧功能相关指标的影响。方法:61例手术患者采用美国美敦力血液回输机进行洗涤式自体血回输,分别测定术前、术后当天、术后第1天、术后第7天血液凝固指标:血小板计数(PLT)、血浆凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、凝血酶时间(TT)、纤维蛋白原(FIB)、D-二聚体(D-D)和红细胞携氧功能相关指标:血氧分压(PaO2)、血氧饱和度(SaO2)、血酸碱度(pH)、红细胞计数(RBC)、血红蛋白含量(HGB)、红细胞压积(Hct)。结果:61例患者术中回收原血和"机血"共84912ml,平均每例患者回输浓缩红细胞465ml。与术前比较,术后当天和术后第1天凝血功能指标PLT、FIB显著降低(P<0.01),PT显著延长(P<0.05或P<0.01),术后当天D-D明显升高(P<0.05);携氧功能指标PaO2在术后当天和术后第1天显著升高(P<0.01),RBC、HGB、Hct均显著降低(P<0.01,P<0.05)。术后第7天所有异常指标均恢复至术前水平。结论:洗涤式自体血回输不影响血液凝固和携氧功能,可安全应用于心脏手术。

Objective: To observe the effect of abstergent autologous blood transfusion on blood coagulation and carrying oxygen function related indicators in patients undergoing cardiac surgery. Method: Autologous blood transfusion in operation of 61 patients were employed by Medtronic autologous blood recovery system. When before operation,the day postoperative,the first day after operation,the seventh day after operation, blood coagulation indicatorssuch as platelet count(PCT), prothrombin time(PT), activated partial thromboplastin time(APTT), thrombin time(TT), fibrinogen(FIB), D-Dimer and erythrocyte carrying oxygen fuction related indicators such as blood oxygen tension(PaO2), blood oxygen saturation(SaO2), concentration of H+(pH),erythrocyte count(RBC), hemoglobin concentration(HGB),hematocrit(Hct) were measured. Results: The total bleeding quantity and the machine remained biood of the 61 patients was 84912ml.The average autologous concentrated red blood transfusion volume was 465ml. When compared with preoperation,PLT,FIB were decreased significantly on the day postoperative and the first day after operation (P<0.01). PT was delayed significantly (P<0.01, P<0.05).The day postoperative D-Dimer was obviously increased(P<0.05).Carrying oxygen fuction related indicators PaO2 was increased markedly on the day postoperative and the first day after operation (P<0.01). RBC,HGB,Hct were decreased significantly(P<0.01, P<0.05). On the seventh day after operation all the abnormal indicators returned to preoperative levels. Conclusion: Autologous blood transfusion did not affect blood coagulation and carrying oxygen fuction,which could be security applied to the cardiac surgery.