急性Stanford A型主动脉夹层术后早期非洗涤式自体血液回收技术的回顾性分析

Exploring safety and efficacy of cell salvage and autologous blood transfusion after acute Stanford A aortic dissection surgery

目的 探索急性A型主动脉夹层术后早期非洗涤式自体血液回收的安全性及有效性。方法 回顾性分析河南省胸科医院心外重症监护病房于2022年4月至2023年12月收治的急性Stanford A型主动脉夹层急诊外科术后患者,根据术后早期是否进行床旁非洗涤式自体血液回收分为试验组(血液回收组)及对照组(未进行自体血液回收)。对比两组术后早期血常规、肝肾功能及凝血功能,术后机械通气时间、ICU滞留时间、术后引流量及异体血制品输注量等数据进行统计学分析,评估床旁非洗涤式自体血液回收在急性A型主动脉夹层术后应用的安全性及有效性。结果 共纳入样本499例,试验组(234例)及对照组(265例),两组患者基线数据无统计学差异。试验组异体血制品输注量明显低于对照组。两组患者术后血常规、肝肾功能及凝血功能总体分布无统计学差异(P>0.05)。试验组术后6 h内平均回收引流自体血液(387.44±219.54)mL,试验组输注异体血制品(840.82±701.89)mL,对照组输注异体血制品(1 171.57±733.33)mL,两组异体输血量总体均数存在统计学差异(t=2.21,P=0.03)。两组患者术后机械通气时间、ICU滞留时间及术后24h引流量总体分布无统计学差异(P>0.05)。结论 急性Stanford A型主动脉夹层术后6 h内床旁非洗涤式自体血液回收安全有效,可明显减少异体血输注量,对预后相关指标未见不良影响。

Objective To explore the safety and effectiveness of early non washable autologous blood recovery after acute stanford a aortic dissection surgery.Methods Retrospective analysis of patients with acute Stanford type A aortic dissection who underwent extracorporeal circulation in the intensive care unit of the Cardiovascular Surgery Center of Henan Chest Hospital from April 2022 to December 2023. According to whether bedside autologous blood recovery was performed in the early postoperative period, they were divided into an experimental group(blood recovery group) and a control group(without autologous blood recovery). Compare the clinical data of early postoperative blood routine, liver and kidney function, coagulation function, postoperative mechanical ventilation time, ICU retention time, postoperative drainage volume, and allogeneic blood product infusion dose between two groups for statistical analysis, to evaluate the safety and effectiveness of non washable autologous blood recovery in the postoperative application of acute type A aortic dissection.Results A total of 499 samples were included, including the experimental group(234 cases) and the control group(265 cases). There was no statistically significant difference in baseline data between the two groups of patients. The infusion volume of allogeneic blood products in the experimental group was significantly lower than that in the control group. There was no statistically significant difference in postoperative blood routine, liver and kidney function, and overall distribution of coagulation function between the two groups of patients(P>0.05). The experimental group received an average recovery of 387.44±219.54mL of autologous blood from the incision within 6 hours after surgery. The experimental group received infusion of 840.82±701.89 mL of allogeneic blood products, while the control group received infusion of 1171.57±733.33 mL of allogeneic blood products. There was a statistically significant difference in the overall mean amount of allogeneic blood transfusion between the two groups(t=2.21, P=0.03). There was no statistically significant difference in the overall distribution of postoperative mechanical ventilation time, ICU stay time, and postoperative drainage volume between the two groups of patients(P>0.05).Conclusion Cell salvage and autologous blood transfusion autologous blood recovery is safe and effective within 6 hours after acute Stanford type A aortic dissection surgery, which can significantly reduce the amount of allogeneic blood transfusion and has no adverse effects on prognosis related indicators.