择期手术患者术前自体血单采备血的应用研究

Application of preoperative autologous apheresis in patients with elective surgery

目的分析术前自体血单采对择期手术患者围术期血液指标、异体血使用情况及术后住院时间、住院费用等的影响,探讨其临床应用价值。方法选取2019年1月至2020年12月在浙江省人民医院择期行外科手术的患者436例。其中218例患者采用术前自体备血与异体备血相结合的方法备血,即术中需要输血时优先输注自体血,如储存的自体血不足,则输注相合的异体血,为自体血单采组;另218例患者符合自体采血标准但采用术前异体备血,为非采血组。比较自体血单采组患者采血前后血液指标,两组患者围术期输血相关指标(术中失血量、补液量、异体血使用情况和住院时间、费用)、血常规指标。结果自体血单采组患者平均单采RBC(2.85±0.41)U,平均单采血浆(233.5±22.57)ml;与采血前相比,采血后RBC下降、Hb下降、红细胞分布宽度(RDW)升高、红细胞比容(HCT)下降(均P<0.05),WBC、PLT、PT、APTT、TT、Fib、国际标准化比值(INR)及血栓弹力图指标凝血反应时间(R值)、凝血形成时间(K值)、凝固角(α角)、凝血最大幅度(MA值)、凝血综合指数(CI值)均无统计学差异(均P>0.05)。自体血单采组患者术中输注异体RBC量、使用异体血比例均小于非采血组患者(均P<0.05)。两组患者术中失血量、手术时长及术中输注晶体液、胶体液、异体血浆量比较差异均无统计学意义(均P>0.05)。自体血单采组术中失血量500~1000 ml者术中输注异体RBC量低于非采血组(P<0.05),住院费用少于非采血组(P<0.05),而住院时间比较无统计学差异(P>0.05)。两组患者采血前、手术后、出院前RBC、Hb、HCT、RDW、WBC、PLT比较均无统计学差异(均P>0.05)。结论择期手术患者术前自体血单采可储备大量自体血液,改变部分血液指标,但并不影响患者相关功能;可显著减少中等失血量手术中异体血的使用比例和使用量,减少住院费用,具有良好的临床应用价值。

Objective To analyze the application of preoperative autologous apheresis in patients undergoing elective surgery.Methods A total of 436 patients scheduled for elective surgery in Zhejiang Provincial People's Hospital from January 2019 to December 2020 were enrolled in the study.Among them,218 patients used a combination of preoperative autologous blood preparation and allogeneic blood preparation,that is,when blood transfusion is needed during the operation,the autologous blood is given priority,if the stored autologous blood is insufficient,the corresponding allogeneic blood will be transfused(autologous apheresis group).The other 218 patients met the standard of autologous blood preparation but used preoperative allogeneic blood preparation used preoperative allogeneic blood preparation(non-apheresis group).The blood indexes in apheresis group were compared before and after autologous apheresis.The perioperative blood transfusion-related indexes(intraoperative blood loss,fluid volume,use of allogeneic blood,hospitalization time,expenses),and blood routine indexes were compared between two groups.Results In the autologous apheresis group,the average apheresis RBC was(2.85±0.41)U,and the average apheresis plasma was(233.5±22.57)ml.Compared with before autologous apheresis,RBC decreased,Hb decreased,red blood cell distribution width(RDW)increased,and hematocrit(HCT)decreased in autologous apheresis group after autologous apheresis(all P<0.05),and there was no significant change in WBC and PLT(both P<0.05).There was no significant difference in PT,APTT,TT,Fib,international normalized ratio(INR)and thromboelastography index co-agulation reaction time(R value),coagulation formation time(K value),coagulation angle(αangle),maximum coagulation(MA val-ue),coagulation composite index(CI value)after autologous apheresis in autologous apheresis group compared with before au-tologous apheresis(all P>0.05).The amount of allogeneic RBC transfused in the autologous apheresis group was lower than those in the non-apheresis group(P<0.05).There was no significant difference in intraoperative blood loss,operation time,and intraoperative crystalloid,colloid,and allogeneic plasma volume between the two groups(all P>0.05).When the intraoperative blood loss was 500-1000 ml,the amount of allogeneic RBC transfused and the proportion of allogeneic RBC used during op-eration in autologous apheresis group were lower than that in non-apheresis group(all P<0.05),and the hospitalization costs in autologous apheresis group were lower than those in the non-apheresis group(P<0.05),but there was no significant difference in the length of hospital stay(P>0.05).There were no significant differences in RBC,Hb,HCT,RDW,WBC,and PLT before au-tologous apheresis,after surgery and before discharge between the two groups(all P>0.05).Conclusion Preoperative autol-ogous apheresis in patients undergoing elective surgery can reserve a large amount of autologous blood,change some blood in-dicators,but does not affect the patient's related functions.Preoperative autologous apheresis in patients undergoing elective surgery can significantly reduce the proportion and the amount of allogeneic blood used in operations with moderate blood loss,also can reduce patient hospitalization cost,therefore it has good clinical application value.