简化血液管理技术在心脏手术中的应用

Application of Simplified Blood Management in Cardiac Surgery

目的探讨简化血液管理技术在心血管外科手术中的应用效果脾低临床用血量和医疗费用。方法广东省人民医院2010年3月至2013年5月共655例心脏手术患者采用简化血液管理技术男316例、女339例,年龄13~78(45.0±13.8)岁简化血液管理的具体措施分为术前、术中、术后三部分。结果共有437例患者实现未输红细胞(66.7%).未输任何血液成份患者403例(61.5%)未输红细胞仅输血浆的患者29例,输血浆和冷沉淀3例输血浆和血小板1例,仅输血小板1例。在未输红细胞的437例患者中,手术后30d内死亡2例,死亡率0.5%,1例死于多脏器功能衰竭,另1例死于心搏骤停。未输红细胞的患者其手术方式和特殊病种包括二尖瓣置换术86例、双瓣置换术75例、主动脉瓣置换术51例、二尖瓣置换术加射频消融41例、房间隔缺损修补术41例、二尖瓣成形术38例、双瓣置换术加射频消融术25例、再次心脏手术23例、室间隔缺损修补术18、冠状动脉旁路移植术十瓣膜置换术10例、粘液瘤切除术8例、感染性心内膜炎瓣膜手术8例、心包剥离5例、非体外冠状动脉旁路移植术4例、Bentall手术4例。在65例既往有心脏手术史的患者中未输红细胞患者23例,占35.4%。结论采用简化血液管理技术可安全有效地降低临床用血量,适用于任何条件的单位和患者值得在临床推广应用。血液回收机并非必需。

Objective To study the effectiveness of simplified blood management in cardiovascular surgery,minimize the need for blood transfusions and decrease the medical care costs.Methods From March 2010 to May 2013,the simplified blood management was applied in 655 patients who underwent cardiovascular surgery in the department of cardiac surgery,Guangdong General Hospital.There were 316 males and 339 females with their age of 13-78(45.0±13.8)years.The techniques of simplified blood management consisted of preoperative strategies,intraoperative strategies,and postoperative strategies.Results There were 437 patients(66.7%) avoiding red cell transfusion in cardiac surgery.Of the437 patients,403(61.5%) without any blood products transfusion,29 had transfusion of plasma transfusion,3 of plasma and cryoprecipitation,one of plasma and platelet,and one of platelet only.Two patients died within 30 days postoperative with 0.5%mortality rate:one died of multiple organ failure,one died of cardiac arrest.The procedures and special etiologies of 437 patients avoiding red cell transfusion included mitral valve replacement in 86 patients,double valve(aortic and mitral) replacement in 75 patients,aortic valve replacement in 51 patients,mitral valve replacement plus modified Maze procedure in 41 patients,atrial septal defect repair in 41 patients,mitral valve repair in 38 patients,double valve replacement plus modified Maze procedure in 25 patients,re-do operation in 23 patients,ventricular septal defect repair in 18 patients,coronary artery bypass grafting plus valve replacement in 10 patients,myxoma excision in 8 patients,subacute bacterial endocarditis in 8 patients,pericardium dissection in 5 patients,off-pump coronary artery bypass grafting in 4 patients,Bentall procedure in 4 patients.Of 65 patients with cardiac surgery history,23(35.4%) were free from red cell transfusion in the second operation.Conclusion Simplified blood management is of benefit to reduce the blood transfusion safely and effectively,no using additional expensive medication and medical devices and therefore without increasing hospital costs.The technique is suitable to any institute and patient.It is worthwhile to be used widely in clinical practice.Cell salvage system is not necessary.