自体血液回收技术中不同浓度肝素抗凝剂在腹部外伤手术中的应用

Application of different concentrations of heparin anticoagulant autologous blood recovery technology in abdominal trauma operation

目的探讨自体血液回收技术应用不同浓度肝素抗凝剂在腹部外伤手术中的效果,为临床自体血液回收选择最适宜的肝素浓度,增加患者自体输血的安全系数。方法将40例腹部外伤手术使用自体血液回收技术的患者随机分为A、B两组,各20例。A组抗凝剂为0.9%生理盐水500 mL加肝素钠12 500 U;B组抗凝剂为0.9%生理盐水500 mL加肝素钠25 000 U,比较两组患者失血量、自体血回输量、手术前后红细胞压积、血小板、凝血酶原时间(PT)、活化凝血酶原时间(APTT)、血红蛋白(Hb)的变化。结果两组患者术中平均失血量A组为(2605.15±29.68)mL,B组为(2611.59±21.58)mL;A组回输量为(1524.86±26.15)mL,B组(1511.24±25.75)mL,差异均无统计学意义(均P>0.05)。而两组组内回输自体血前与回输自体血后比较Hb、红细胞压积(HCT)差异均有统计学意义(均P<0.05),PT、APTT的差异则无统计学意义(均P>0.05)。结论通过分析自体血液回收不同浓度肝素抗凝剂在腹部外伤手术中的应用效果,认为12 500 U肝素浓度作为抗凝剂可用于自体血液回收,安全可靠。

Objective To study the effect of autologous blood recovery with different concentrations of heparin in anticoagulant application in abdominal trauma surgery. To choose a most suitable concentration of heparin for clinical autologous blood recovery amd to increase the safety factor of autologous blood transfusion in patients. Methods 40 cases of patients with abdominal trauma using autologous blood recovery operation were randomly divided into A and B group. A group included 20 cases, B group included 20 cases. In group A ,anticoagulant was used with 500 mL of 0.9% saline water and heparin sodium 12500 U. Anticoagulant was used with 0.9% saline water 500 mL and heparin sodium 25000 U in group B. The blood loss, autologous blood back to the throughput, red blood cells deposited before and after operation, the change of platelet, PT, APTT, Hb in patients of two groups were compared. Results Patients with median intraoperatie blood loss in group A was （2605.1 ±29. 680） mL, less than that in group B （ 2611.59 ±21.58 ） mL. The back throughput was （ 1524.86 ±26.15 ） mL in group A, and （ 1511.24 ±25.75 ） mL in group B, preoperatively. No statistical significance was found between back after autologous blood group A and group B. There was a statistical significance in doping and doping of autologous blood before autologous blood after comparing Hb, HCT （ P 〈 0.05 ）. There was no statistical significance in PT and APTT（ P 〉 0. 05 ）. Conclusion On the basis of the analysis of autologous blood recovery of different concentrations of heparin anticoagulant application effect in abdominal trauma surgery ,we found 12500 U do anticoagulant heparin concentration for autologous blood recovery is the most safe and reliable.