洗涤式自体血回输在外伤性颅内出血急症手术中的应用价值

The application value of washing-type autologous blood transfusion in treatment for traumatic intracranial hemorrhage by emergency surgery

目的探讨洗涤式自体血回输在外伤性颅内出血急诊手术中的应用价值。方法选取外伤性颅内出血急症手术住院病例43例,手术中采用洗涤式自体血液回输方法,将手术野积血、继续出血回收,经过林格氏液稀释、洗涤后制成新鲜红细胞悬液,即时回输给患者。记录手术过程中的出血量与自体洗涤血回输量。监测指标:采集手术前、后静脉血和洗涤后的回输血,分别检测三个时段的血常规、血浆无机离子、凝血功能等参数变化,并记录围输血期不良反应(过敏、溶血、感染等)情况。结果 43例颅脑外伤患者回输洗涤后自体血量为455~2250 ml,平均输血量为745 ml/例,未监测到输血不良反应。术后24 h患者红细胞、血红蛋白、白细胞等数值均有提高,与手术前比较差异具有统计学意义;回输后24 h患者的凝血功能、血浆无机离子等数值稳定,与手术前各项参数比较差异无统计学意义。结论洗涤式自体血回输技术用于外伤性颅内出血患者,可以实现即时性血液回输效果,尤其适用于急诊颅脑手术,具有节约血源、减少库血输入量的价值,可以有效降低异体输血出现并发症的几率。

Objective:To evaluate the application value of cathartic blood transfusion in emergency surgery for traumatic intracranial hemorrhage.Methods:Forty-three cases of traumatic intracranial hemorrhage emergency surgery in hospital patient were selected and used for washing in the operation of autologous blood doping method,hemorrhage was recycled through the ringer's solution made from fresh red blood cell suspension after dilution and washing,and the loss was returned instantly to patients.The blood volume of the operation was recorded and the blood volume was returned.Monitoring indicators included venous blood and blood transfusion after the acquisition before the operation,after washing,routine blood and plasma parameters such as inorganic ions,blood coagulation function changes were tested at three different times respectively,and the time of transfusion reactions(allergies,hemolysis,infections,etc.)was recorded.Results:The blood volume of43patients with craniocerebral trauma was455~2250ml,and the average blood transfusion was745ml/case,unmonitored transfusions.The number of erythrocytes,haemoglobin and white blood cells were improved in24h after surgery,and the difference was statistically significant before surgery.The coagulation function and plasma inorganic ion of24h patients were stable after transfusion,and the differences were not statistically significant compared to those before surgery.Conclusion:Washing-type of autologous blood doping technology used in patients with traumatic intracranial bleeding,can realize the immediacy of blood doping effect,which is especially suitable for emergency brain surgery,save blood source,and can effectively reduce the risk of allogeneic blood transfusion complications.