库存红细胞两步法水浴复温后输注可行性的研究

Observation on feasibility of blood transfusion heater applied for packed red blood cells transfusion with two-step method

目的探讨两步法涡流水浴加温模式用于大量快速输血的可行性.方法随机选取库存红细胞悬液血样,于水浴复温前、后采样,分别进行细菌定性培养、血气分析、游离血红蛋白(FHb)含量测定.为测试加温效能,水浴温度均设定为(37.5±0.5)℃,实验随机分四组:两步法涡流水浴加温组A(n=10),血袋涡流水浴加温组B(n=10),血袋静止水浴加温组C(n=10),输血器管路涡流水浴加温组D(n=10).各组血样分别以10、20、30、40、50及60 mL/min的速度进行输注,记录血样的输出端温度.结果血样复温前后的细菌学测定均为阴性;复温后各组血样的红细胞计数(RBC)、红细胞压积(HCT)、血清钾离子(K+)浓度及FHb含量与复温前比较差异无统计学意义(P>0.05);A组以10、20、30、40、50及60 mL/min的速度进行模拟输注,输出末温度(℃:35.0±0.2,34.1±0.1,33.4±0.2,33.1±0.2,33.0±0.2,32.7±0.2)均在32℃以上,明显高于B、C、D组(P<0.001).结论两步法涡流水浴加温模式具有安全、高效、便捷等特点,适用于临床大量、快速输血加温.

Objective To observe feasibility of blood transfusion heater applied for packed red blood cells (RBC) transfusio with two-step method. Methods Blood gas analysis, hemolysis and blood bacterial culture were determined for the red blood cells before and after heating (n = 10). In order to test the heating efficiency, the water bath temperature was set at (37. 5 ±0. 5)℃,and the blood samples were divided into four groups (n = 10): group A, both the bag of red blood cells and intravenous tubing were warmed in the water bath with stirring;group B, only the bag of red blood cells was warmed in the water bath;group C, only the bag of red blood cells was wanned in the water bath;group D, only the intravenous tubing were warmed in the water bath with stirring. The temperature was monitored at the outlet of the infusing line for all groups when the flow rate was set at 10, 20, 30, 40, 50, 60 mL/min, and the output temperature of the blood samples was recorded. Results The qualitative test of bacterial culture for all blood samples was all negative. There was no significant difference in the red blood cells count, hematocrit, potassiumions concentration and free hemoglobin between groups (P〉0. 05). The output temperature in group A (℃:35. 0±0.2, 34.1 ±0.1, 33.4 ± 0.2, 33.1 ±0.2, 33.0 ±0.2, 32.7 ±0.2) was more than 32℃. that was significantly higher than the output temperature in group B, group C, and group D at the same flow rate level (P < 0. 001). Conclusion This two-step vortex water heating bath has the characteristics of safety, high efficiency, and convenience. It is suitable for clinical rapid and large blood transfusion.