自体成分输血在1例Rh阴性体外循环心脏手术中的应用
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摘要
目的采用自体成分输血联合急性等容血液稀释的方式在体外循环心脏手术中为患者输血,评价其安全性,为高难度外科手术开展自体输血提供参考。方法在充分了解患者的临床资料和病史的基础上,采用术前蛙跳式自体成分贮血联合术中急性等容血液稀释的方式进行血液的采集和回输。结果患者在未输注异体血的情况下完成了体外循环下冠状动脉搭桥手术,患者在血液采集和回输过程中生命体征平稳,手术顺利,未出现输血不良反应。结论自体输血作为一种有效的血液保护手段,对于符合条件的择期手术患者应该积极开展自体成分输血,特别是稀有血型患者可以节省宝贵的血液资源,贮存式联合急性等溶血液稀释自体输血对心脏手术患者是安全、实用、经济的输血方式,值得临床上广泛使用。
Objective To evaluate the safety of blood component autotransfusion combined with acute normovolemic hemodilution(ANH)in cardioplumonary bypass(CPB)open heart surgery, providing case reference for developing autotransfusion in complex surgical operation. Methods After carefully considering the clinical data and patient medical history, blood component autotransfution combined with ANH was proposed and planned for the transfusion. Results The surgery was successful and the patient recovered smoothly without transfusion homologous blood during perioperative period. The patient,s vital sign was stable with no transfusion adverse reactions. Conclusions The autotransfusion proposed an effective blood conservation approach. Patients are now offered with a promising option, especially for the rare blood type patients. The blood component autotransfusion combined with ANH in heart surgical operation, in this case, was safe, practical, low blood consumption, and worth promoting in clinical practices.
Objective To evaluate the safety of blood component autotransfusion combined with acute normovolemic hemodilution(ANH)in cardioplumonary bypass(CPB)open heart surgery, providing case reference for developing autotransfusion in complex surgical operation. Methods After carefully considering the clinical data and patient medical history, blood component autotransfution combined with ANH was proposed and planned for the transfusion. Results The surgery was successful and the patient recovered smoothly without transfusion homologous blood during perioperative period. The patient,s vital sign was stable with no transfusion adverse reactions. Conclusions The autotransfusion proposed an effective blood conservation approach. Patients are now offered with a promising option, especially for the rare blood type patients. The blood component autotransfusion combined with ANH in heart surgical operation, in this case, was safe, practical, low blood consumption, and worth promoting in clinical practices.
引文
[1] 张志永,黄宇光.术中自体血回输的临床和研究进展.中国输血杂志,2014,27(11):1093-1095.
[2] Yu X,Huang Y,Qu G,et al.Safety and current status of blood transfusion in China.Lancet,2010,375(9724):1420-1421.
[3] 谢应强,夏玲,刘玉革,等.逆行自体血预充方法用于心肺转流先心病手术血液保护的效果.临床麻醉学杂志,2014,30(12):1161-1163.
[4] 邓硕曾.血液保护与节约用血. 中国输血杂志,2002,15(4):294-296.
[5] 卫生部.临床输血技术规范.卫医发[2000\]184号.2000.
[6] 邓硕曾,宋海波,刘进. 循证输血与输血指南. 中国输血杂志,2006,19(4):263-264.
[7] Singbart G.Pre-operative autologous blood donation:clinical parameters and efficacy.Blood Transfusion,2011,9(1):10-18.
[8] 熊圣仁,余光书,熊国胜,等.自体输血在全膝关节置换术应用的Meta分析. 中国输血学杂志,2018,31(3)267-269.
[9] Oh AY,Seo KS,Lee GE,et al.Effect of preoperative autologous blood donation on patients undergoing biomaxillary orthognathic surgery:a retrospective analysis. Int J Oral Maxillofac Surg,2016,4(4):486-489.
[10] 沈社良,谢屹红,郑嘉寅,等.自体血液回收-回输对CPB心脏手术患者围术期凝血功能的影响.中华麻醉学杂志,2014,34(3)270-274.
[11] Reyher C,Bingold TM,Menzel S,et al.Impact of acute normovolemic hemodilution on primary hemostasis.Anaesthesist,2014,63(6):496-498.
[12] Papadopoulos N,Bakhtiary F,Grun V,et al.The effect of normovolemic modified ultrafiltration on inflammatory mediators,endotoxins,terminal complement complexes and clinical outcome in high-risk cardiac surgery patients.Perfusion,2013,28(4):306-308.
[2] Yu X,Huang Y,Qu G,et al.Safety and current status of blood transfusion in China.Lancet,2010,375(9724):1420-1421.
[3] 谢应强,夏玲,刘玉革,等.逆行自体血预充方法用于心肺转流先心病手术血液保护的效果.临床麻醉学杂志,2014,30(12):1161-1163.
[4] 邓硕曾.血液保护与节约用血. 中国输血杂志,2002,15(4):294-296.
[5] 卫生部.临床输血技术规范.卫医发[2000\]184号.2000.
[6] 邓硕曾,宋海波,刘进. 循证输血与输血指南. 中国输血杂志,2006,19(4):263-264.
[7] Singbart G.Pre-operative autologous blood donation:clinical parameters and efficacy.Blood Transfusion,2011,9(1):10-18.
[8] 熊圣仁,余光书,熊国胜,等.自体输血在全膝关节置换术应用的Meta分析. 中国输血学杂志,2018,31(3)267-269.
[9] Oh AY,Seo KS,Lee GE,et al.Effect of preoperative autologous blood donation on patients undergoing biomaxillary orthognathic surgery:a retrospective analysis. Int J Oral Maxillofac Surg,2016,4(4):486-489.
[10] 沈社良,谢屹红,郑嘉寅,等.自体血液回收-回输对CPB心脏手术患者围术期凝血功能的影响.中华麻醉学杂志,2014,34(3)270-274.
[11] Reyher C,Bingold TM,Menzel S,et al.Impact of acute normovolemic hemodilution on primary hemostasis.Anaesthesist,2014,63(6):496-498.
[12] Papadopoulos N,Bakhtiary F,Grun V,et al.The effect of normovolemic modified ultrafiltration on inflammatory mediators,endotoxins,terminal complement complexes and clinical outcome in high-risk cardiac surgery patients.Perfusion,2013,28(4):306-308.