体外循环心脏术后纵隔引流液的回输

THE REINFUSION OF SHED MEDIASTINAL BLOOD AFTER CARDIAC OPERATION UNDER EXTRACORPOREAL CIRCULATION

目的 探讨体外循环心脏术后早期纵隔引流液回输对异体库血用量、血液凝血机制、肾功能的影响。方法将40例体外循环心脏术后4h内纵隔引流液量超过400ml的患者,随机分为纵隔引流回输组和对照组各20例。记录术后24h异体库血用量和术后4-24h纵隔引流液量,并于术后4h、12h和24h检测血液凝血酶原时间、血小板计数、血小板聚集率、纤维蛋白原、纤维蛋白原降解产物和肌酐水平。结果 回输组术后24h异体库血用量明显少于对照组,术后4-24h纵隔引流液量二组差异无显著性,术后4h、12h和24h的凝血酶原时间、血小板计数、血小板聚集率、纤维蛋白原、纤维蛋白原降解产物和肌酐水平二组差异无显著性。结论 体外循环心脏术后早期纵隔引流液的回输是减少术后异体库血应用的一种有效方法,这种方法并不影响血液凝血机制和增加出血,也不影响肾功能。

Objective To investigate the influence of reinfusion of shed mediastinal blood after cardiac operation during early period under extracorporeal circulation on the volume of allogeneic banked blood transfusion, hemostatic mechanism and renal function. Methods 40 consecutive cases performing cardiac operations under extracorporeal circulation, whose volume of shed mediastinal blood were more than 400ml in the first 4 postoperative hours, were randomly divided into shed mediastinal blood rein-fusion group(reinfusion group) and control group, each containing 20 cases. The volume of allogeneic banked blood transfusion in the first 24 postoperative hours and that of shed mediastinal blood from postoperative 4th to 24th hour were recorded. Plasmogenic time, platelet count platelet aggregation function, fibrinogen, fibrinogen degradation production and creatine level of circulating blood in 4、12、 24hours postoperative were recorded. Results The volume of allogeneic banded blood transfused of re-infusion group was significantly less than that of control group. There was no significant difference in the volume of shed mediastinal blood from postoperative 4th to 24th hour between 2 groups. There we- re no significant differences in plasmogenic time, platelet count, platelet aggregation function, fibrino-gen, fibrinogen degradation products and creatine levels between 2 groups. Conclusion Reinfusion of shed mediastinal blood postoperation during early period under extracordoreal circulation is an effective way to reduce the volume of postoperative allogeneic banked blood transfusion; There has no significant negative effect, and no influence on hemostatic mechanism and renal function.