Blood loss during liver transplantation (OLTx) is a common consequence of pre-existing abnormalities of the hemostatic system,portal hypertension with multiple collateral vessels,portal vein thrombosis,previous abdomi...Blood loss during liver transplantation (OLTx) is a common consequence of pre-existing abnormalities of the hemostatic system,portal hypertension with multiple collateral vessels,portal vein thrombosis,previous abdominal surgery,splenomegaly,and poor "functional" recovery of the new liver.The intrinsic coagulopathic features of end stage cirrhosis along with surgical technical difficulties make transfusion-free liver transplantation a major challenge,and,despite the improvements in understanding of intraoperative coagulation profiles and strategies to control blood loss,the requirements for blood or blood products remains high.The impact of blood transfusion has been shown to be significant and independent of other well-known predictors of posttransplant-outcome.Negative effects on immunomodulation and an increased risk of postoperative complications and mortality have been repeatedly demonstrated.Isovolemic hemodilution,the extensive utilization of thromboelastogram and the use of autotransfusion devices are among the commonly adopted procedures to limit the amount of blood transfusion.The use of intraoperative blood salvage and autologous blood transfusion should still be considered an important method to reduce the need for allogenic blood and the associated complications.In this article we report on the common preoperative and intraoperative factors contributing to blood loss,intraoperative transfusion practices,anesthesiologic and surgical strategies to prevent blood loss,and on intraoperative blood salvaging techniques and autologous blood transfusion.Even though the advances in surgical technique and anesthetic management,as well as a better understanding of the risk factors,have resulted in a steady decrease in intraoperative bleeding,most patients still bleed extensively.Blood transfusion therapy is still a critical feature during OLTx and various studies have shown a large variability in the use of blood products among different centers and even among individual anesthesiologists within the same center.Unfortunately,despite the large number of OLTx performed each year,there is still paucity of large randomized,multicentre,and controlled studies which indicate how to prevent bleeding,the transfusion needs and thresholds,and the "evidence based" perioperative strategies to reduce the amount of transfusion.展开更多
目的:研究贮存式自体血输注(preoperative autologous blood donation,PABD)在普外科择期手术中的临床应用效果。方法:筛选2017年11月-2018年8月本院普外科贮存式自体血输注70例,采用配对研究方法,将未采用贮存式自体血输注且术前基线...目的:研究贮存式自体血输注(preoperative autologous blood donation,PABD)在普外科择期手术中的临床应用效果。方法:筛选2017年11月-2018年8月本院普外科贮存式自体血输注70例,采用配对研究方法,将未采用贮存式自体血输注且术前基线资料无统计学差异的70例患者,配对作为对照组。比较2组患者异体红细胞和血浆输注量,围术期Hb和Plt变化,住院时间及住院费用的差异。结果:PABD组采血前、后Hb和Plt分别为138.26±14.73 vs 127.52±13.36g/L(P<0.05)和(221.67±52.86 vs 198.35±52.65)×10^9/L(P>0.05);2组患者围术期异体红细胞和血浆的输注量分别为0.20±0.71 vs 0.89±0.97 U和30.43±100.81 vs 106.52±152.61 ml(P<0.05);2组患者术前Hb水平135.65±14.16 vs 134.15±11.98 g/L,术前Plt水平(270.36±58.28 vs 271.67±65.02)×10^9/L;术后1 d Hb水平120.24±14.40 vs 121.20±14.30 g/L,术后1 d Plt水平(241.80±63.58 vs 241.30±69.11)×10^9/L;术后3 d Hb水平123.15±13.80 vs 121.65±14.33 g/L,术后3 d Plt水平(251.26±72.94 vs 255.54±73.85)×10^9/L;出院前Hb水平122.78±13.92 vs 122.00±13.82 g/L,出院前Plt(262.50±80.96 vs 264.56±71.08)×10^9/L(P>0.05);2组患者的住院时间14.84±3.37 vs 14.84±2.24(d)(P>0.05),住院总费用和输血相关费用分别为50627.27±9889.45 vs 50979.43±8195.00元和354.39±362.57 vs 684.02±425.53元(P<0.05)。结论:择期手术估计术中失血量1000ml的患者,贮存式自体血输注的应用可节约异体血输注,降低费用。展开更多
目的探讨单采深度自体储血技术(advanced autologous apheresis,AAA)在择期特大手术中的节血效果。方法选择本院2012年1月-2015年12月行巨大神经纤维瘤择期手术的15例患者,根据是否进行AAA分为深度自体组和对照组,比较2组患者的基本资...目的探讨单采深度自体储血技术(advanced autologous apheresis,AAA)在择期特大手术中的节血效果。方法选择本院2012年1月-2015年12月行巨大神经纤维瘤择期手术的15例患者,根据是否进行AAA分为深度自体组和对照组,比较2组患者的基本资料、手术前后Hb和Plt、住院时间、术中出血量、术中自体血回收量、术前自体浓缩红细胞和血小板采集量、术中异体红细胞、血浆及血小板的输注量。结果 1)2组患者基线水平一致,手术前后Hb和Plt、住院时间均无统计学差异(P>0.05);2)深度自体组和对照组患者术中出血量分别为2 000 mL(1 200,3 500)vs 2 600 mL(1 000,3 875)(P>0.05),术中自体血回收量为44 U vs 9 U;3)2组术前自体浓缩红细胞和自体血小板采集总量分别为68 U vs 4 U、17 U vs 0 U;4)2组围手术期异体红细胞、血浆和血小板的输注总量分别为18 U vs 53 U、24 U vs 66 U、2 U vs 4 U;5)深度自体组有5例患者避免了异体血输注,占55.6%(5/9)。结论单采深度自体储血技术能在短时间内获得大量的自体红细胞和自体血小板,具备避免特大择期手术患者使用异体红细胞和异体血小板的巨大潜力。展开更多
文摘Blood loss during liver transplantation (OLTx) is a common consequence of pre-existing abnormalities of the hemostatic system,portal hypertension with multiple collateral vessels,portal vein thrombosis,previous abdominal surgery,splenomegaly,and poor "functional" recovery of the new liver.The intrinsic coagulopathic features of end stage cirrhosis along with surgical technical difficulties make transfusion-free liver transplantation a major challenge,and,despite the improvements in understanding of intraoperative coagulation profiles and strategies to control blood loss,the requirements for blood or blood products remains high.The impact of blood transfusion has been shown to be significant and independent of other well-known predictors of posttransplant-outcome.Negative effects on immunomodulation and an increased risk of postoperative complications and mortality have been repeatedly demonstrated.Isovolemic hemodilution,the extensive utilization of thromboelastogram and the use of autotransfusion devices are among the commonly adopted procedures to limit the amount of blood transfusion.The use of intraoperative blood salvage and autologous blood transfusion should still be considered an important method to reduce the need for allogenic blood and the associated complications.In this article we report on the common preoperative and intraoperative factors contributing to blood loss,intraoperative transfusion practices,anesthesiologic and surgical strategies to prevent blood loss,and on intraoperative blood salvaging techniques and autologous blood transfusion.Even though the advances in surgical technique and anesthetic management,as well as a better understanding of the risk factors,have resulted in a steady decrease in intraoperative bleeding,most patients still bleed extensively.Blood transfusion therapy is still a critical feature during OLTx and various studies have shown a large variability in the use of blood products among different centers and even among individual anesthesiologists within the same center.Unfortunately,despite the large number of OLTx performed each year,there is still paucity of large randomized,multicentre,and controlled studies which indicate how to prevent bleeding,the transfusion needs and thresholds,and the "evidence based" perioperative strategies to reduce the amount of transfusion.
文摘目的:研究贮存式自体血输注(preoperative autologous blood donation,PABD)在普外科择期手术中的临床应用效果。方法:筛选2017年11月-2018年8月本院普外科贮存式自体血输注70例,采用配对研究方法,将未采用贮存式自体血输注且术前基线资料无统计学差异的70例患者,配对作为对照组。比较2组患者异体红细胞和血浆输注量,围术期Hb和Plt变化,住院时间及住院费用的差异。结果:PABD组采血前、后Hb和Plt分别为138.26±14.73 vs 127.52±13.36g/L(P<0.05)和(221.67±52.86 vs 198.35±52.65)×10^9/L(P>0.05);2组患者围术期异体红细胞和血浆的输注量分别为0.20±0.71 vs 0.89±0.97 U和30.43±100.81 vs 106.52±152.61 ml(P<0.05);2组患者术前Hb水平135.65±14.16 vs 134.15±11.98 g/L,术前Plt水平(270.36±58.28 vs 271.67±65.02)×10^9/L;术后1 d Hb水平120.24±14.40 vs 121.20±14.30 g/L,术后1 d Plt水平(241.80±63.58 vs 241.30±69.11)×10^9/L;术后3 d Hb水平123.15±13.80 vs 121.65±14.33 g/L,术后3 d Plt水平(251.26±72.94 vs 255.54±73.85)×10^9/L;出院前Hb水平122.78±13.92 vs 122.00±13.82 g/L,出院前Plt(262.50±80.96 vs 264.56±71.08)×10^9/L(P>0.05);2组患者的住院时间14.84±3.37 vs 14.84±2.24(d)(P>0.05),住院总费用和输血相关费用分别为50627.27±9889.45 vs 50979.43±8195.00元和354.39±362.57 vs 684.02±425.53元(P<0.05)。结论:择期手术估计术中失血量1000ml的患者,贮存式自体血输注的应用可节约异体血输注,降低费用。
文摘目的探讨单采深度自体储血技术(advanced autologous apheresis,AAA)在择期特大手术中的节血效果。方法选择本院2012年1月-2015年12月行巨大神经纤维瘤择期手术的15例患者,根据是否进行AAA分为深度自体组和对照组,比较2组患者的基本资料、手术前后Hb和Plt、住院时间、术中出血量、术中自体血回收量、术前自体浓缩红细胞和血小板采集量、术中异体红细胞、血浆及血小板的输注量。结果 1)2组患者基线水平一致,手术前后Hb和Plt、住院时间均无统计学差异(P>0.05);2)深度自体组和对照组患者术中出血量分别为2 000 mL(1 200,3 500)vs 2 600 mL(1 000,3 875)(P>0.05),术中自体血回收量为44 U vs 9 U;3)2组术前自体浓缩红细胞和自体血小板采集总量分别为68 U vs 4 U、17 U vs 0 U;4)2组围手术期异体红细胞、血浆和血小板的输注总量分别为18 U vs 53 U、24 U vs 66 U、2 U vs 4 U;5)深度自体组有5例患者避免了异体血输注,占55.6%(5/9)。结论单采深度自体储血技术能在短时间内获得大量的自体红细胞和自体血小板,具备避免特大择期手术患者使用异体红细胞和异体血小板的巨大潜力。
