贮存式及回收式自体血回输在脑膜瘤手术中的应用

Application of stored and recovered autologous blood transfusion in meningioma surgery

目的探讨贮存式及回收式自体血回输在脑膜瘤手术中的应用效果及护理策略。方法回顾性分析桂林医学院附属医院自2012年9月至2020年12月术中使用了贮存式和/或回收式自体血回输的65例脑膜瘤手术患者。根据手术患者在术前、输血前、输血后、术后四个时间段的体温(T)、心率(HR)、平均动脉压(MAP)、脉搏血氧饱和度(SPO_(2)),术前、术后的血常规中血红蛋白浓度(HB)、红细胞压积(HCT)、白细胞(WBC)、血小板(PLT)及凝血功能的凝血酶原时间(PT)、凝血酶时间(TT)、部分凝血活酶时间(APTT)、纤维蛋白原(FIB)的结果,观察贮存式、术中回收式自体输血在脑膜瘤手术中的应用效果。结果65例患者术中出血共35 600ml,人均400 (300,700)ml;自体血回输共35 400ml,人均400 (250,650)ml,其中贮存式20 700 ml和回收式14 700 ml。术前、输血前、输血后、手术后的T、HR、MAP、SPO_(2)比较,差异有统计学意义(P <0.05),术前和术后WBC、HB、HCT、PLT比较,差异有统计学意义(P <0.05),但所有指标都在正常范围内,未达到输异体血指标。术前和术后的PT、APTT、FIB、TT比较,差异无统计学意义(P> 0.05)。结论在脑膜瘤手术过程中,采取贮存式及回收式自体血回输是安全可靠的,不仅节约血源,还可以避免了输注异体血导致的疾病传播和免疫抑制等风险。

Objective To investigate the application effect and nursing strategy of stored and recovered autologous blood transfusion in meningioma surgery.Methods A total of 65 patients with meningioma admitted to Affiliated Hospital of Guilin Medical University who used stored and/or recovered autologous blood transfusion during the operation from September 2012 to December 2020 were retrospectively analyzed.According to the body temperature(T),heart rate(HR),mean arterial pressure(MAP),and pulse oxygen saturation(SPO_(2))of the surgical patients before operation,before blood transfusion,after blood transfusion and after operation,and hemoglobin of blood(HB),hematocrit(HCT),white blood cells(WBC),platelets(PLT)in blood routine,and the results of prothrombin time(PT),thrombin time(TT),activated partial thromboplastin time(APTT)and fibrinogen(FIB)of coagulation function before and after operation,the application effects of stored and intraoperative recovered autologous blood transfusion in meningioma surgery were observed.Results The intraoperative hemorrhage volume of 65 patients was 35600 ml in total,with an average of 400(300,700)ml per capita;Autologous blood transfusion totaled 35400 ml,with an average of 400(250,650)ml per capita,in which 20700 ml was stored and 14700 ml was recovered.There were statistically significant differences in T,HR,MAP and SPO_(2) in four time periods,namely before operation,before blood transfusion,after blood transfusion and after operation(P<0.05).There were statistically significant differences in WBC,HB,HCT and PLT before and after operation(P<0.05).However,all the indices were within the normal range and did not reach the target of allogeneic blood transfusion.There were no statistically significant differences in PT,APTT,FIB and TT before and after operation(P>0.05).Conclusion In the process of meningioma surgery,it is safe and reliable to use stored and recovered autologous blood transfusion,which not only saves blood sources,but also avoids the risks of disease transmission and immunosuppression,etc.,caused by allogeneic blood transfusion.