少量出血患者使用术中回收式自体输血有效性的随机对照研究

Effectiveness of Intraoperative Autotransfusion in Mild-bleeding Surgery:a Randomized Controlled Trial

目的探讨术中回收式自体输血（intraoperative autotransfusion,IAT）能否改善少量出血患者的组织氧合及术后恢复。方法选择2011年12月至2012年4月在北京协和医院行腰椎后路手术、美国麻醉医师协会（American Society of Anesthesiologists,ASA）分级为Ⅰ~Ⅱ级且预计出血量〈20%血容量的患者,随机分为两组,回输组输注回收自体血,对照组给予等量胶体液。检测两组患者术前、术中及术后血红蛋白（hemoglobin,Hb）、乳酸及脑氧饱和度,随访并比较术后恢复指标,包括体温、不适主诉、切口愈合、下地行走时间及术后住院时间。结果共38例患者纳入本研究,回输组和对照组各19例。回输组术后0.5 h和术后1 d的Hb均高于术中水平[分别为（116.5±10.7）、（115.4±12.3）、（106.6±12.6）g/L;P=0.001,P=0.004],而对照组术后Hb与术中比较差异无统计学意义（P〉0.05）。对照组术后0.5 h乳酸高于术前[（2.5±1.0）mmol/L比（1.3±0.6）mmol/L,P=0.016],而回输组术后乳酸与术前比较差异无统计学意义（P〉0.05）。术后Hb、乳酸及脑氧饱和度两组间差异均无统计学意义（P〉0.05）。两组术后恢复指标差异亦均无统计学意义（P〉0.05）。结论在健康成人患者少量出血手术中使用IAT,对术后早期组织氧合有一定改善作用,但对术后恢复无显著影响。

Objective To investigate the effectiveness of intraoperative autotransfusion （ IAT） in impro-ving tissue oxygenation and postoperative recovery in patients undergoing mild -bleeding surgery .Methods We selected patients scheduled for posterior lumbar surgery at Peking Union Medical College Hospital from December 2011 to April 2012 , at American Soceity of Anesthesiologists grade Ⅰ-Ⅱ, and with estimated blood loss less than 20%of their blood volume .The patients were randomly divided into the IAT group （ given salvaged autologous blood） and the control group （given equal volume of colloid solution instead ）.Hemoglobin （Hb） level, lactate level, and cerebral oxygen saturation before , during, and after the surgery were compared between the two groups . Postoperative recovery indexes of the 2 groups were compared , including body temperature , chief complaint , wound healing , ambulation time , and postoperative length of stay .Results Thirty-eight patients were enrolled and randomly divided into the IAT group （n=19） and the control group （n=19）.In the IAT group, postop-erative half-hour and postoperative 1-day Hb levels were （116.5 ±10.7） g/L and （115.4 ±12.3） g/L, re-spectively, both significantly higher than the intraoperative level [（106.6 ±12.6） g/L; P =0.001, P =0.004 ];while no such significant differences were found in the control group （ P〉0.05 ） .Lactate level was significantly elevated at postoperative half-hour compared with preoperative level in the control group [ （2.5 ± 1.0） mmol/L vs.（1.3 ±0.6） mmol/L, P=0.016], while the trend was absent in the IAT group.There were no significant differences in postoperative Hb level , lactate level, and cerebral oxygen saturation between the two groups （ P〉0.05 ） , nor in any of the postoperative recovery indexes （ P〉0.05 ） .Conclusion The use of IAT in healthy adult patients undergoing surgery with estimated small blood loss could improve early tis-sue oxygenation after the surgery , but with no significant influence on postoperative recovery .