不同指标床旁快速评估回收血清除率的可靠性

Reliability of different parameters for rapid bedside evaluation of clearance rates of salvaged blood

目的 评价游离血红蛋白（fHb）、K＋和Ca2＋清除率床旁快速评估回收血清除率的可靠性.方法 拟行自体血回收-回输技术的外科手术患者26例,年龄18～ 80岁,BMI＜32 kg/m2,性别不限,ASA分级Ⅰ-Ⅲ级,采用CATS型血液回收机回收术野出血.分别检测大流量、标准、高质量3种清洗模式下白蛋白（Alb）、fHb、K＋和Ca2＋的清除率.结果 与Alb清除率比较,3种清洗模式下K＋清除率（＜90％）和Ca2＋清除率降低（差值＜5％）,大流量清洗模式下fHb清除率降低（差值＜5％）（P＜0.01）,标准和高质量清洗模式下差异无统计学意义（P＞0.05）.不同清洗模式之间各指标清除率比较差异无统计学意义（P＞0.05）.结论 采用CATS型自体血回收机进行血液回收时,Ca2＋和fHb清除率可作为床旁快速评估回收血清除率的指标,而Ca2＋因其检测更加方便,较fHb更具优越性.

Objective To evaluate the reliability of the clearance rates of free hemoglobin （fHb）, K＋ and Ca22＋ for rapid bedside evaluation of the clearance rates of the salvaged blood.Methods Twenty-six patients of both sexes, aged 18-80 yr, with body mass index〈32 kg/m22, of American Society of Anesthesiologists physical status [-Ⅲ, scheduled for elective surgery requiring autologous blood withdrawalreinfusion, were involved in this study.An autotransfusion device （continuous autotransfusion system, Fresenius） was used to collect the blood shed from the surgical field and to process the salvaged blood during the surgery.The clearance rates of albumin （Alb） , fHb, K＋ and Ca22＋ were detected in three washing modes （big flux, standard, high quality）.Results Compared with the clearance rate of Alb, the clearance rates of K＋ （〈90%） and Ca2＋ were significantly decreased in three washing modes （the difference 〈5%） , the clearance rate of fHb was decreased in the big flux washing mode （the difference 〈5%） （P〈0.05）, and no significant change was found in the clearance rate of fHb in the standard and high quality washing modes （P〉0.05）.There was no significant difference in the clearance rates of each parameter between the three washing modes （P 〉 0.05）.Conclusion When the autotransfusion device continuous autotransfusion system is used to collect the blood, the clearance rates of flHb and Ca2＋ can be used as parameters for rapid bedside evaluation of the clearance rates of the salvaged blood, while Ca2 ＋detection is more convenient, and therefore it is superior to fHb.