自体输血在基层医院神经外科手术中应用的临床分析

Clinical analysis of the application of autologous blood transfusion in neurosurgery of primary hospital

目的：观察自体输血在基层医院神经外科手术中的应用价值。方法选取行神经外科手术且术中需要输血患者414例，其中术中行自体输血97例（观察组），术中行异体输血317例（对照组），比较两组患者术中输血情况、血红蛋白和红细胞压积（HCT）的变化及输血相关费用。结果观察组和对照组手术时间、输液量、输血相关并发症发生率和术后血红蛋白、HCT比较差异均无统计学意义（P〈0.05）。对照组输注异体血量共189000 ml，输异体血占总输注液体量比例为79.22%（189000/238580）；观察组13例患者输注了异体血，共5400 ml，输异体血占总输注液体量比例为10.30%（5400/52430）。观察组86例患者（88.66%，86/97）进行了自体血采集并回输，共采集自体血80650 ml，回输47020 ml。另外11例患者没有回输，其中6例为人为操作不规范或机械原因没有回收，5例自体血回收但没有回输。输注6U及以上异体浓缩悬浮红细胞费用明显高于自体血回输费用[（2287.06±243.52）元比（1595.08±133.95）元]，差异有统计学意义（P＜0.05）。对照组14.83%（47/317）的患者输注6 U异体浓缩悬浮红细胞，6.62%（21/317）的患者输注超过6U。结论基层医院神经外科应用自体输血在节约用血、保障用血和降低异体血需求方面安全有效；但在使用过程中应强化使用者操作技能，确保自体输血医疗质量。

Objectives To observe the clinical significance and application value of autologous blood transfusion in neurosurgery of primary hospital. Methods Four hundred and fourteen patients who underwent the neurosurgery operation and were subjected to intraoperative blood transfusion were selected, among whom 97 patients were subjected to autologous blood transfusion （observation group）, and 317 patients were subjected to heterogenous blood transfusion （control group）. The condition of intraoperative blood transfusion, changes of hemoglobin and hematocrit, blood transfusion related cost were compared between 2 groups. Results There were no statistical differences in operation time, infusion volume, rate of transfusion related complications and postoperation hemoglobin, hematocrit between observation group and control group （P＆gt;0.05）. The patients in control group were infused with 189 000 ml, and the transfusion liquid volume proportion of total blood transfusion was 79.22%（189 000/238 580）;13 patients in observation group were used the heterogenous blood transfusion with 5 400 ml, and the transfusion liquid volume proportion of total blood transfusion was 10.30%（5 400/52 430）. Eighty-six patients （88.66%, 86/97） in observation group performed autologous blood collection and transfusion, the volume of autologous collection was 80 650 ml, and the volume of transfusion was 47 020 ml. Eleven patients in observation group did not perform autologous blood transfusion, among whom 6 patients was because of operational and mechanical reasons, and 5 patients performed collection but did not transfuse. The cost of heterogenous concentrated suspension red blood cell over 6 U was significantly higher than the cost of disposable material and injection of autologous blood：（2 287.06 ± 243.52） yuan vs. （1 595.08 ± 133.95） yuan, and there was statistical difference （P〈0.05）. The rate of heterogenous concentrated suspension red blood cell 6 U in control group was 14.83%（47/317）, and the rate of over 6 U was 6.62%（21/317）. Conclusions The autologous blood transfusion is safe and effective, and it is worth popularizing in neurosurgery of primary hospital. But in the process of its application, it is necessary to strengthen the user′s operating skills and ensure the quality of autologous blood transfusion.