心脏手术输血方式的探讨

Analysis of the formula of blood transfusion during cardiac surgery in our hospital

目的分析探讨本院择期心脏手术患者输血方式及异体血输注量差异,为今后的临床工作提供一定的参考信息。方法搜集本院2016年1月1日-12月31日共计115例获得明确临床诊断的心脏手术患者的临床输血资料,分析其性别、年龄、血型、病种的分布情况,并对其输血方式和各种异体成分血的输注情况进行回顾性的统计分析。结果 115例术中输血的心脏手术患者中,81例患者应用自体输血,方式均为术中回收式,其中76例亦有异体血输注,5例仅输注自体血;34例术中仅输注异体血。术中应用自体输血的患者年龄明显高于无自体输血者,有自体输血者以冠状动脉硬化性心脏病(冠心病)和风湿性心脏瓣膜病(风心病)居多,其手术风险大,多是2种输血方式并用,其中,冠心病手术患者男性明显多于女性;术中没有自体输血的患者多是先天性心脏病(先心病)的儿童,其术中异体血的输注量明显低于老年心脏手术患者。各个血型间平均用血量无显著差异,不同病种间各成分血平均用量可见显著差异。结论心脏手术多数需要施行体外循环,操作时间长,出血量多,因此用血量很大,应根据病种做好术前备血工作,并积极开展自体输血等血液保护措施。

Objective To analyze the formula of blood transfusion and the difference in donor blood transfusion volume in patients undergoing elective cardiac surgery, so as to provide some reference information for clinical work in the future. Methods Clinical blood transfusion data on a total of 115 cases of clear clinical diagnosis in patients undergoing cardiac surgery in our hospital from January 1, 2016 to December 31, 2016 were collected. The distribution of gender, age, blood type, disease type was analyzed. The formula of blood transfusion and the transfusion volume of allogeneic blood components were studied in a retrospective statistical analysis. Results Of 115 cases of patients undergoing cardiac surgery with intraop-erative blood transfusion, 81 cases were intraoperative salvaged autotransfusion, including 76 eases with allogeneic blood transfusion, 5 cases with sole infusion of autologous blood; 34 cases with only allogeneic blood transfusion. The age of patients with intraoperative autotransfusion was significantly higher than that of non autologous blood transfusion. The majority of autotransfusion patients had coronary heart disease （CHD） and rheumatic heart disease （ RHD ）, whose operation risk is high and two kinds of blood transfusion methods were used. Among these patients, the number of male patients with coronary heart disease was significantly higher than female patients. The patients without autotransfusion were mostly children with con- genital heart disease. The amount of allogeneic blood transfusion were significantly lower than that of the elderly patients with cardiac surgery. The average volume of allogeneic blood transfusion had no significant difference among each blood group. There was significant difference in the average volume of allogeneic blood transfusion among different diseases. Conclusion Majority of cardiac surgeries need extracorporeal circulation due to longer operation time and higher bleeding amount, hence the usage of blood is proportionally higher. We should do better in the preparation of preoperative blood, and actively carry out blood conservation measures, such as autologous blood transfusion.