术中使用血液回收机的节约用血效果及其对凝血功能的影响

Effect of Intraoperative Using Cell Saver on Blood Sparing andIts Impact on Coagulation Function

目的 观察术中使用血液回收机 cell saver CS 的节约用血效果及其对患者血液学和凝血功能的影响。方法 选择各类择期手术患者 138例,使用 CS 行术野血液回收。分别测定术前、回收血液全部回输后及术后 1d血常规、生化及凝血功能指标。结果 共回收浓缩红细胞悬液 112056m l,平均每例 812m l。自体输血量占输血总量的 48%～89%,异体输血率为 5%～100%。与术前相比,输入回收血液后和术后 1d 血红蛋白浓度、血小板计数、总蛋白及血浆纤维蛋白原浓度显著降低 P <0.05或 P <0.01,而凝血酶原时间显著延长 P <0.05。结论 术中使用CS 可在一定程度上减少对库血的需求量,但大量输入回收的血液可影响凝血功能。

Objective To observe the effectiveness of using cell saver(CS)during surgery on blood sparing and its impact on patient′s hematology and coagulation function. Methods One-hundred and thirty-eight patients undergoing elective surgery were recruited for intraoperative blood salvage using CS. Blood routine, blood chemistry and coagulation function were measured before surgery, after infusion of salvaged blood and postoperative day 1, respectively. Results In total, 112 056 ml of packed red blood cells were collected, with a mean value of 812 ml per patient. The percentage of autologous blood transfusion volume to the total blood transfusion volume was from 48% to 89%. Allogenic blood transfusion rate was from 5% to 100%. Compared with the values before surgery, the hemoglobin concentration, platelet count, plasma total protein and fibrinogen concentration decreased significantly after the transfusion of salvaged blood and the first postoperative day(P < 0.05 or P < 0.01), while the prothrombin time was significantly prolonged(P < 0.05). Conclusions The use of CS during surgery can, to a certain extent, reduce the requirement of allogenic blood. However, reinfusion of large amount of salvaged blood may affect coagulation function.