自体血液稀释及术中出血回输方法在骨科手术中的应用

The use of autohemodilution and intraoperative retransfusion of the blood loss during orthopaedic surgery

目的 介绍采用自体血液稀释法和术中出血回输法进行输血的初步经验。方法 1998年 9月～ 1999年 10月对 70例骨科择期手术患者采用自体输血技术，稀释法 24例，术中出血回输法 46例。观察患者术前、术中、术后的血流动力学、血液有形成分和凝血功能变化。结果 稀释组中 15例（ 62.5％）单纯采用自体血液稀释法完成手术，另 9例加输库存血，其用血量较以往同类手术明显减少。术中出血回输组的回收总血量为 49 669 ml，平均每例回收 1 080 ml，与对照组比较人均输库存血量减少 72.5％。 70例患者术中血流动力学稳定，均顺利完成手术，无不良反应。结论 采用血液稀释法和术中出血回输法进行自体输血与输库存血比较，差异无显著性意义 (P >0.05)，故血液稀释法及术中出血回输法用于骨科手术是安全、可行的方法。

Objective This is a description of our preliminary experience in the use autohemodilution and the method of intraoperative transfuse back of the blood loss during orthopaedic surgery. Methods Seventy patients undergone orthopaedic surgery had received autologous blood transfusion from September 1998 to October 1999. The patients were divided into two groups. The first group of 24 patients received hemodilution. In the second group of 46 patients the blood lost during the surgery was retrieved. Pre- and post-operation as well as during the operation the changes of hemodynamics, blood shaped components, coagulative function were observed. Results In the group of hemodilution, 15 patients (62.5％ ) sustained the operation with hemodilution, the other 9 patients gone through the operation with hemodilution and allogeneic blood transfusion. But the amount of allogeneic blood transfusion is about as half as the amount of similar operation before. In the group given the retrieved blood, the total amount of blood used was 49 669 ml,in an average of 1 080 ml in the individual patient. In the group recieved retrieved blood, the average volume of allogeneic blood transfusion significantly reduced by 72.5％ compared with the control groups. During operation 70 patients had a smooth course, without adverse reaction following a successful operation. Conclusion No remarkable changes(P >0.05) were seen among the cases given autohemotransfusion including hemodilution and the use of retrieved blood comparing with the allogeneic transfusion. Therefore, hemodilution and retrieving blood for retransfusion are safe and reliable ways to be adopted in orthopaedic surgery.