120例回收式自体输血在非停跳冠状动脉旁路移植术中的临床应用分析

The application of salvaged autologous blood transfusion in off-pump coronary artery bypass grafting

目的:观察回收式自体输血在非停跳冠状动脉旁路移植术(OPCABG)中应用的临床效果。方法:我院择期行OPCABG ASAⅡ～Ⅲ,心功能Ⅱ～Ⅲ(NYHA),且自愿接受自体血回输患者120例。监测患者术前及术中HR、平均动脉压(MAP)、氧分压(PaO2)、血细胞比容(Hct)、血小板计数(PLT)、活化凝血时间(ACT)及凝血酶原时间(PT)等的变化。同时分别于术前和回输后采外周静脉血2 mL,自体血回输前,即刻采集同体积洗涤红细胞涂片,显微镜下观察红细胞形态,且留取回输前即刻至回输后3h内的尿样行尿血红蛋白定性检测。结果:自体血回输前MAP较术前下降,HR略有升高,回输后二者已基本恢复到术前水平;而Hb,Hct和PLT均较术前明显降低,PT延长;而自体血回输后,HB、HCT显著回升,机体低血红蛋白状态得到改善;自体血回输后,PLT和PT在正常范围内,较回输前无明显变化;ACT值略有下降,但同术前相比,差异无统计学意义(P>0.05)。洗涤红细胞涂片可见红细胞棘状变形,约4～6个/高倍视野,占总数的15%～25%,偶见红细胞碎片,而自体血回输后涂片,红细胞形态大致正常,少见变形红细胞,未见红细胞碎片。尿血红蛋白定性检测结果:血红蛋白尿弱阳性3例,血红蛋白尿比例为2.5%。结论:回收式自体输血可节约血源,纠正失血及贫血,维持血流动力学稳定,对凝血功能无明显影响,在非体外循环冠状动脉旁路移植术中,回收式自体输血作为一种血液保护措施,可应用于临床。

Objective：To investigate the clinical effect of intraoperative autologous blood salvage and transfusion in off-pump coronary artery bypass grafting（OPCABG）. Methods： One hundred and twenty ASA II III, NYHA II III patients aged 45 68 yr undergoing elective OPCABG were enrolled in this study. The parameters such asHR, MAP, PaO2, Hb, Hct, PLT, ACT and PT were observed before and during the opera- tion. The venous blood samples were gained before the operation and after autologous blood transfusion respec- tively. The salvaged RBCs were examined by microscope to find their morphological changes before infused to the patients. The hemoglobin in patients＇ urine samples were monitored within 3 hours after the autologous blood transfused. Results： Before transfusion, MAP decreased while HR increased slightly, and after transfu- sion both of them were recovered to their preoperative level; Before transfusion, Hb, Hct and PLT were signifi- cantly decreased and PT were also prolonged. While after transfusion, Hb and Hct were greatly improved. After transfusion PLT and PT were still in the normal range, there was no significant variation. After transfusion, ACT were slightly decreased, but there was no statistical significance when compare with its preoperative level. Abnomal RBCs＇ shape were observed on washed red blood cell smear（4 - 6/HPF）, accounting for 15% to 25% of the total RBCs＇ amount. But after transfusion, the morphology of the red cells was normal roughly, few of them were deformed and none was fragmented. Only 3 patients＇ results of uHB testing showed weakly posi-tive and the hemoglobinuria ratio was 2. 5%. Conclusion： Intraoperative autologous blood salvage and transfu- sion is very useful on blood conservation, which can salvage the blood effectively and be feasible to use in OP- CABG.