预存式自体血回输技术在择期体外循环心脏手术中的临床应用

Clinical application of preoperative autologous blood donation in selective cardiac surgery under extracorporeal circulation

目的研究预存式自体血回输技术(PABD)在择期体外循环(cardiopulmonary bypass,CPB)心脏手术中的临床应用效果,探讨PABD的安全性及可行性。方法纳入2015年1月—2021年7月安徽医科大学第一附属医院心脏外科使用预存式自体血回输技术行择期体外循环心脏手术的81例患者为观察组,按性别相同、基础血红蛋白(hemoglobin,Hb)±1.5g/dL、术式相同或相近且由同一治疗组完成的原则,从同期使用异体输血行择期体外循环心脏手术的患者中按1∶1的比例进行匹配作为对照组。比较2组患者在血制品输注量、输血相关费用、术后恢复指标、术后相关并发症发生率等方面的差异。结果与对照组比较,观察组总库存红细胞(red blood cell,RBC)输注量[2.00(0.00,4.00)U vs.5.50(4.00,8.00)U]、总血浆输注量[600.00(400.00,800.00)mL vs.800.00(600.00,1325.00)mL]、术后24 h引流量[445.00(310.00,567.50)mL vs.575.00(433.50,860.00)mL]、机械通气时间[16.00(8.00,18.00)h vs.18.00(11.00,26.00)h]、监护室(intensive care unit,ICU)停留时间[43.00(36.00,65.00)h vs.58.00(41.00,94.00)h]均显著降低(均P<0.05)。观察组术后急性肾衰竭、血红蛋白尿、机械通气时间延长等并发症发生率均显著低于对照组(均P<0.05)。2组患者输血相关费用比较差异有统计学意义(P<0.05)。结论预存式自体血回输技术可显著减少患者异体红细胞及血浆输注量,且有利于降低术后并发症发生率,促进患者术后恢复。

Objective This study aimed to investigate the clinical values of preoperative autologous blood donation(PABD)in selective cardiac surgeries under extracorporeal circulation(SCSUEC)and to discuss the safety and feasibility of PABD.Methods A total of 81 patients who consecutively received SCSUEC combined with PABD in the First Affiliated Hospital of Anhui Medical University from January 2015 to July 2021 were enrolled as the experimental group.Another 81 patients from the same hospital were matched by gender and baseline haemoglobin level(±1.5 g/dL),and they received SCSUEC at a ratio of 1∶1,which were determined as the case control.Comprehensive comparisons in the transfusion amount of allogenic RBC and plasma,the cost of transfusion,the postoperative recovery parameters and postoperative complications were conducted between the two groups.Results Compared with the case control,participants in the experimental group have significantly less allogenic RBC transfusion[2.00(0.00,4.00)U vs.5.50(4.00,8.00)U],less allogenic plasma transfusion[600.00(400.00,800.00)mL vs.800.00(600.00,1325.00)mL],less first 24 h drainage[445.00(310.00,567.50)mL vs.575.00(433.50,860.00)mL],shorter mechanical ventilation time[16.00(8.00,18.00)h vs.18.00(11.00,26.00)h]and shorter ICU stay[43.00(36.00,65.00)h vs.58.00(41.00,94.00)h]were significantly decreased(all P<0.05).Furthermore,less incidence of acute renal failure,haemoglobinuria and prolonged mechanical ventilation were observed in the experimental group(all P<0.05).The difference in costs related to blood transfusion was statistically significant between two groups(P<0.05).Conclusion PABD can reduce the demand for allogenic RBC and plasma transfusion in SCSUEC.It can also be used to avoid postoperative complications and promote postoperative recovery.