大量输入悬浮红细胞与经血液回收机处理悬浮红细胞在全身麻醉手术患者中的应用及对患者凝血功能的影响
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摘要
目的探究大量输入悬浮红细胞与经血液回收机处理悬浮红细胞在全身麻醉手术患者中的应用及对患者凝血功能的影响。方法选取我院2015年2月～2016年7月期间收治的在临床中需要进行大量输注悬浮红细胞的全身麻醉手术的患者60例,随机将其分成两组。其中一组为研究组,将对需要输血的患者使用经血液回收机处理过的悬浮红细胞输入;另一组为对照组,将对需要输血的患者大量输入悬浮红细胞。对比两组输入方式对患者产生的不同效果以及对患者凝血功能的影响。结果治疗后两组患者PT、APTT、FIB以及TT等指标均显著低于治疗前,且研究组患者显著低于对照组(P<0.05);研究组患者菌血症、细菌感染及破裂出血等不良反应发生情况方面显著少于对照组(P<0.05);研究组患者下床活动时间、住院天数及手术出血量均显著低于对照组(P<0.05)。结论对需要进行大量输血并进行全身麻醉手术的患者采取使用经血液回收机处理悬浮红细胞输入的方式在临床上的使用效果较好于大量输入悬浮红细胞的方法,应用也较为广泛,对患者的凝血功能造成的影响也相对较小,是一种安全有效的临床应用方案,值得在实际临床操作中大力推广使用。
Objective To investigate the application of massive infusion of suspended red blood cells and the treatment of suspended red blood cells by blood recovery machine in the patients undergoing general anesthesia and its effects on coagulation function. Methods 60 patients who underwent general anesthesia and were in need of massive infusion of suspended red blood cells clinically in our hospital from February 2015 to July 2016 were selected in the study, and they were randomly divided into two groups. One group was the study group, and the patients in need of blood transfusion were given the infusion of red blood cells processed by the blood recovery machine; the other group was the control group, and the patients in need of blood transfusion were given massive infusion of suspended red blood cells. The different effects of the two infusion methods on the patients and the effect on the patient's coagulation function. Results After treatment, the PT, APTT, FIB and TT indexes of the two groups were significantly lower than those before treatment, and the study group was significantly lower than the control group(P<0.05); the incidence rate of adverse reactions such as bacteremia, bacterial infection and rupture of bleeding in the study group was significantly lower than that in the control group(P<0.05); the time of off-bed activity, the number of hospital stays, and the amount of surgical bleeding in the study group were significantly lower than those in the control group(P<0.05). Conclusion For patients who need massive blood transfusions and undergo general anesthesia, the method of using the blood recovery machine to process the infusion of suspended red blood cell is better in clinical use than the massive infusion of red blood cells, and the applications are also more extensive. The impact on the patient's coagulation function is also relatively small. It is a safe and effective clinical application program, which is worthy of widespread promotion and application in actual clinical operations.
Objective To investigate the application of massive infusion of suspended red blood cells and the treatment of suspended red blood cells by blood recovery machine in the patients undergoing general anesthesia and its effects on coagulation function. Methods 60 patients who underwent general anesthesia and were in need of massive infusion of suspended red blood cells clinically in our hospital from February 2015 to July 2016 were selected in the study, and they were randomly divided into two groups. One group was the study group, and the patients in need of blood transfusion were given the infusion of red blood cells processed by the blood recovery machine; the other group was the control group, and the patients in need of blood transfusion were given massive infusion of suspended red blood cells. The different effects of the two infusion methods on the patients and the effect on the patient's coagulation function. Results After treatment, the PT, APTT, FIB and TT indexes of the two groups were significantly lower than those before treatment, and the study group was significantly lower than the control group(P<0.05); the incidence rate of adverse reactions such as bacteremia, bacterial infection and rupture of bleeding in the study group was significantly lower than that in the control group(P<0.05); the time of off-bed activity, the number of hospital stays, and the amount of surgical bleeding in the study group were significantly lower than those in the control group(P<0.05). Conclusion For patients who need massive blood transfusions and undergo general anesthesia, the method of using the blood recovery machine to process the infusion of suspended red blood cell is better in clinical use than the massive infusion of red blood cells, and the applications are also more extensive. The impact on the patient's coagulation function is also relatively small. It is a safe and effective clinical application program, which is worthy of widespread promotion and application in actual clinical operations.
引文
[1]孟祥雪,鲍红光,顾飞,等.不同种类液体急性等容血液稀释对脊柱手术患者血流动力学的影响和血液保护效应[J].临床麻醉学杂志,2016,32(1):15-19.
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[8]虞芳,钟涛,武钢.输注高/低比例血浆及红细胞对创伤后需大量输血救治患者疗效的meta分析[J].南方医科大学学报,2017,37(1):119-123.
[9] Ritchie D M. Filtration of dilute erythrocyte suspension as a measure of erythrocyte deformability and its relationship to blood glucose control in diabetes mellitus[J].2016,5(3):257-268.
[10]李涓,程智刚.采用血栓弹力图评估不同麻醉方式对膝关节置换术患者血液凝固动态变化的影响[J].中国现代医学杂志,2016,26(16):114-117.
[11] Arpac覦H,觭Comu FM,Kü觭ük A,et al. Effects of lornoxicam and intravenous ibuprofen on erythrocyte deformability and hepatic and renal blood flow in rats[J]. Drug Design Development&Therapy,2016,10(13):2477-2481.
[12]胡建,方志勇,纪木火,等.术中输注不同保存时间库存红细胞对老年髋关节置换术患者术后谵妄的影响[J].临床麻醉学杂志,2017,33(4):394-396.
[13] Swanepoel AC,Emmerson O,Pretorius E. The Effect of endogenous and synthetic estrogens on whole blood clot formation and erythrocyte structure[J]. Microscopy&Microanalysis,2017,23(34):1-11.
[14]宿明艳,张晓坤,王喆妍,等.右美托咪定对胃癌手术老年患者红细胞糖代谢限速酶和血糖及丙二醛浓度的影响[J].临床麻醉学杂志,2016,32(12):1162-1164.
[15] Shurkhina ES,Polyanskaya TY, Zorenko VY,et al. Effect of hematocrit and erythrocyte density on intraoperative blood loss in hemophilia a patients during total knee arthroplasty[J]. Bulletin of Experimental Biology&Medicine,2016,161(1):37-40.
[16]许琳蔚,魏小磊,魏永强,等.左旋门冬酰胺酶与培门冬酶对成人急性淋巴细胞白血病患者凝血功能的影响及相关因素分析[J].中国实验血液学杂志,2016,24(1):30-35.
[17] Nikhil M,Jean S,Omoruyi FO. Oxidative stress parameters and erythrocyte membrane adenosine triphosphatase activities in streptozotocin-induced diabetic rats administered aqueous preparation ofkalanchoe pinnata leaves[J].Pharmacognosy Research,2016,8(2):85-88.
[18]刘刚,魏秀玲,杨林江,等.中度高海拔地区肺部手术后早期使用低分子肝素抗凝对凝血功能的影响及安全性[J].广东医学,2016, 37(6):871-873.
[19] Giani F,Fiorini C,Wakabayashi A,et al. Targeted application of human genetic variation can improve red blood cell production from stem cells[J]. Cell Stem Cell,2016,18(1):73-78.
[20]张彦峰,罗伟雄,罗伟文.连续性静脉-静脉血液滤过联合血液灌流对严重脓毒症患者凝血功能的影响[J].广东医学,2016,37(13):1987-1989.
[2]李修良,董鹏,张晔,等.择期心脏手术患者术中回收自体血液红细胞2,3-二磷酸甘油酸和游离血红蛋白水平的变化研究[J].中国输血杂志,2016,29(11):1232-1235.
[3] Shi XM,Li JW,Zhu LZ,et al. Destructive effect of DBCD plasma on HBsAg in human blood and its impact on erythrocyte functions[J]. IEEE Transactions on Plasma Science,2016,44(9):1815-1822.
[4]王叙德,刘华高,方有智,等.氨甲环酸对肝癌患者肝切除手术出血量及术后凝血功能的影响[J].中国临床药理学杂志,2017(23):2351-2353.
[5]纪雪红,韦爱芬,刘晓芬,等.颅脑手术治疗患者术中自体血液回输与异体输血对其临床疗效影响及感染研究[J].中华医院感染学杂志,2017,27(1):124-127.
[6] Soumya R,Carl H,Vani R. l-carnitine as a potential additive in blood storage solutions:A study on erythrocytes[J].Indian Journal of Hematology&Blood Transfusion An Official Journal of Indian Society of Hematology&Blood Transfusion,2016,32(3):328-329
[7]林培容,侯宇希,赵丽云,等.急性血小板分离技术对深低温停循环主动脉手术患者凝血功能的影响[J].临床麻醉学杂志,2016,32(5):421-425.
[8]虞芳,钟涛,武钢.输注高/低比例血浆及红细胞对创伤后需大量输血救治患者疗效的meta分析[J].南方医科大学学报,2017,37(1):119-123.
[9] Ritchie D M. Filtration of dilute erythrocyte suspension as a measure of erythrocyte deformability and its relationship to blood glucose control in diabetes mellitus[J].2016,5(3):257-268.
[10]李涓,程智刚.采用血栓弹力图评估不同麻醉方式对膝关节置换术患者血液凝固动态变化的影响[J].中国现代医学杂志,2016,26(16):114-117.
[11] Arpac覦H,觭Comu FM,Kü觭ük A,et al. Effects of lornoxicam and intravenous ibuprofen on erythrocyte deformability and hepatic and renal blood flow in rats[J]. Drug Design Development&Therapy,2016,10(13):2477-2481.
[12]胡建,方志勇,纪木火,等.术中输注不同保存时间库存红细胞对老年髋关节置换术患者术后谵妄的影响[J].临床麻醉学杂志,2017,33(4):394-396.
[13] Swanepoel AC,Emmerson O,Pretorius E. The Effect of endogenous and synthetic estrogens on whole blood clot formation and erythrocyte structure[J]. Microscopy&Microanalysis,2017,23(34):1-11.
[14]宿明艳,张晓坤,王喆妍,等.右美托咪定对胃癌手术老年患者红细胞糖代谢限速酶和血糖及丙二醛浓度的影响[J].临床麻醉学杂志,2016,32(12):1162-1164.
[15] Shurkhina ES,Polyanskaya TY, Zorenko VY,et al. Effect of hematocrit and erythrocyte density on intraoperative blood loss in hemophilia a patients during total knee arthroplasty[J]. Bulletin of Experimental Biology&Medicine,2016,161(1):37-40.
[16]许琳蔚,魏小磊,魏永强,等.左旋门冬酰胺酶与培门冬酶对成人急性淋巴细胞白血病患者凝血功能的影响及相关因素分析[J].中国实验血液学杂志,2016,24(1):30-35.
[17] Nikhil M,Jean S,Omoruyi FO. Oxidative stress parameters and erythrocyte membrane adenosine triphosphatase activities in streptozotocin-induced diabetic rats administered aqueous preparation ofkalanchoe pinnata leaves[J].Pharmacognosy Research,2016,8(2):85-88.
[18]刘刚,魏秀玲,杨林江,等.中度高海拔地区肺部手术后早期使用低分子肝素抗凝对凝血功能的影响及安全性[J].广东医学,2016, 37(6):871-873.
[19] Giani F,Fiorini C,Wakabayashi A,et al. Targeted application of human genetic variation can improve red blood cell production from stem cells[J]. Cell Stem Cell,2016,18(1):73-78.
[20]张彦峰,罗伟雄,罗伟文.连续性静脉-静脉血液滤过联合血液灌流对严重脓毒症患者凝血功能的影响[J].广东医学,2016,37(13):1987-1989.