骨科术后伤口引流血液自体回输的临床应用

目的：观察由骨科患者术后伤口引流液中回收洗涤浓缩红细胞的含量和细胞功能的变化,并探讨自体血液再回输的护理方法。方法：选择利用自体血液回输的患者30例,术中使用自体血回输仪,术后将处理后的浓缩红细胞回输给患者。在术前、术中以及术后6 h内,进行血常规和生化检查,并统计学分析。结果：30例患者共回输浓缩血量达6 876 mL,平均每例219 mL,自体血回吸收率为75%,患者术前、术后Hb及Hct比较有统计学意义（P〈0.05）。结论：术后使用自体血回输仪,及时回收了伤口引流失去的血液,减少术后患者对异体输血的需要量,是安全有效的血液回输技术。     

体外肺膜氧合支持治疗患者自体血回输的回顾性分析

目的对11例体外肺膜氧合(ECMO)支持治疗患者自体血回输的回顾分析,探讨自体血回输在体外肺膜氧合支持治疗中的临床应用及疗效评价。方法选择2018年10月-2019年5月行ECMO治疗的患者,在其心肺功能恢复,撤机后,将体外管道内的血液收集于一次性使用塑料血袋内,处理后再进行回输。比较回输前后血液分析及凝血功能的变化,对自体血回输后疗效进行评价;对回收后的血液检测5d内的溶血率及进行细菌培养,对贮存血液质量进行评价。结果行ECMO治疗患者自体血回输后,Hb、Plt结果较自体血回输前明显升高,输血疗效显著;凝血功能无明显变化。自体血在2-6℃环境下保存5 d内溶血率远低于国家血液质量标准,连续5 d细菌培养无菌生长,所有患者均未发生输血不良反应。结论行ECMO治疗的患者自体血回输疗效显著、安全可靠、费用低廉。随着ECMO技术的推广,为避免血液浪费,有效节约血液资源,切实降低输血风险,自体血回输技术可广泛应用于ECMO患者。     

川芎嗪在自体血回输对NK细胞功能的影响

目的探讨川芎嗪对自体血回输患者NK细胞功能的影响。方法40例择期行脊柱手术患者,ASA分级Ⅰ～Ⅱ级,随机分成两组,即实验组和对照组,每组20例。实验组于收集血液前30min静脉滴注川芎嗪4mg／kg,在回收血液的肝素盐水和洗涤盐水内加入川芎嗪,终浓度为0．05mg／ml;对照组不予静滴川芎嗪,肝素盐水和洗涤盐水内不加川芎嗪。采集术前、回输自体血后1h、1d、5d的静脉血,使用流式细胞仪测定NK细胞（CD16＋56）的水平。结果对照组CD16＋56回输后1h明显升高,术后1d下降至术前水平,术后第5天比术前明显下降,实验组在回输后1h、1d较术前明显升高,至术后第5天仍在术前水平,在回输后第5天对照组明显低于实验组。结论对照组较实验组在回输自体血后NK细胞功能受到明显的抑制,表明川芎嗪在自体血回输中的应用对NK细胞功能具有一定的保护作用。     

老年患者全膝关节置换术后伤口引流血回输安全性评价

目的探讨老年患者全膝关节置换术后伤口引流血处理和回输的安全性,为老年患者全膝关节置换后伤口引流血回输提供依据。方法选取64例全膝关节置换老年患者,按照传统的方法,接引流袋引流记量并弃去的32例患者为对照组;另外32例患者作为观察组,在对照组的基础上,将患者术后6 h内的伤口引流血通过一次性自体输血过滤器过滤后再经过白细胞过滤器过滤后回输,并分析观察回输后的输血反应。比较两组患者术后伤口引流量、异体输血量、住院天数、拆线天数、切口感染、深静脉血栓的发生率。结果观察组回输处理好的伤口引流血后未出现输血不良反应;观察组异体输血量、住院天数、切口感染、深静脉血栓、拆线天数与对照组有明显差异,差异均有统计学意义(P均0.05)。结论老年患者全膝关节置换术后伤口引流血经处理后回输是安全的,可以节约日趋紧张的血液资源,减少传染疾病的传播,降低患者费用,合理医疗资源,值得推广应用。     

自体血回输在腰椎后路融合内固定手术中的应用

目的探讨自体血回输技术在腰椎后路融合内固定手术中的应用。方法将64例进行腰椎后路融合内固定手术的患者分为2组,分别于术中实施自体血回输和输异体血的输血治疗,于术前、术后24h监测血红蛋白浓度（Hb）和红细胞压积（HCT）、凝血活酶时间（PT）、部分凝血活酶时间（APTT）、凝血酶原时间（TT）,并记录所有病例的术中出血量、术后引流量及输库存血量,实验组还需记录自体血回输量。结果采用自体血回输的33例患者共回输自体血25 770ml,仅部分手术节段多的患者输库存血共2 600ml,而对照组31例患者共输库存血33 000ml。结论在腰椎后路融合内固定手术中应用自体血回输技术能明显节约血源,且安全有效。     

胆汁回输的时效性护理研究

目的 探讨胆汁回输的有效时间和方法。方法 选择无胆道感染、择期行“T”管引流的胆道手术患者12例,分别于术后第1天胆汁引流后的0,6,12,24和30h留取胆汁做胆酸浓度测定和细菌培养。结果 胆汁引流12～24h后胆酸浓度明显降低,且胆汁引流的时间越长,细菌培养的阳性率亦越高。结论 回输胆汁最好在胆汁引流后的12h内完成。     

术中自体血回输在骨科重大手术中的应用

目的:探讨术中自体血回输在骨科重大手术中的应用。方法:对38例择期骨科重大手术,估计出血量超过900m l的患者进行自体血细胞回输,分别观察术前1h、术后1h、24h、72h红细胞计数(RBC)、血红蛋白(Hb)、血细胞压积(HCT)、血小板计数(PLT)、凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、纤维蛋白原(Fg)。结果:平均每例回收血细胞685m。l术后1h、24h PLT低于术前水平(P<0.05),PT和APTT也较术前有所延长(P<0.05),但术后72h接近术前。结论:术中自体血回输对机体凝血功能无明显不良影响,能明显减少库血用量,是一种有效的血液保护措施。     

自体血回输器在人工关节置换术后的应用与护理

目的探讨人工全髋、全膝关节置换术术后采用自体血回输器的应用效果,方法2006—2007年在我院行单侧人工全髋全膝置换术患者40例,其中20例采用自体血回输（A组）,20例未采用自体血回输（B组）。比较两组患者术后引流量、自体血回输量和异体血使用量,以及术后第1、3、7天的血红蛋白和红细胞压积;观察两组患者输血后不良反应的发生情况。结果A组术后自体血回输量平均373．5mL,术后有2例接受异体血回输,平均异体血输入量40mL;B组术后平均异体血输入350mL。自体血回输于术后6h内进行,所有自体血回输未出现输血反应,无感染等并发症。B组有1例出现异体输血反应,表现为皮疹,对症治疗后消退。结论单侧全髋全膝关节置换术后使用自体血回输能够减少术后异体输血量,使用自体血回输器方法简单、安全,可减少因输入异体血导致并发症的发生。     

自体血回输与急性等容量血液稀释对脊柱外科手术患者全身炎症反应的影响

目的自体血回输与急性等容量血液稀释对脊柱外科手术患者全身炎症反应的影响。方法将60例脊柱外科手术患者,随机分为对照组、自体血回输组、急性等容量血液稀释组,每组20例。对照组在术中出血多时就输入异体库存血。自体血回输组在术中联合使用自体血回收装置,血红蛋白低下时就输库存血。急性等容量血液稀释组先经外周静脉输入一定晶体液或胶体液,再经颈内静脉缓慢的抽出机体血液装入专用的含有抗凝的血袋内,经血液摇摆机不停地摇动,适当的时候输入。术前(T1)、术后2h(T2)、6h(T3)、12h(T4)及24h(T5)各时间点抽血5mL,检测白细胞(WBC)、白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)水平,记录术后有无并发症。结果自体血回输组和急性等容量血液稀释组回收血WBC计数均高于T1检测结果,差异有统计学意义(P0.05);3组患者在T2～T5时间点血清IL-6、TNF-α及WBC水平与T1时间点检测结果比较显著增高,但均明显低于对照组,差异有统计学意义(P0.05);术后随访无一例并发症。结论自体血回输组和急性等容量血液稀释组可以有效降低术中及术后全身炎症反应,明显节约血资源。     

胸血自体回输后患者体内抗心肌抗体的检测

目的　了解胸血自体回输后患者抗心肌抗体 (anticardiacmuscleantibody ,ACMA)的产生情况 ,为临床自体血回输工作的开展提供科学依据。方法　用ELISA法检测血清中的ACMA ,设心胸创伤或心脏手术患者实施自体血回输的实验组 ,与心胸创伤未进行自体血回输对照组及正常人对照组进行对照。结果　实验组的ACMA检出率是 11.4 3% ,心胸创伤未进行自体血回输组的ACMA检出率是 9.76 % ,两组结果的差异无显著性(χ2 =0 .0 5 6 ,0 .5 0 0 >P >0 .2 5 0 ) ,但这两组的检出率均明显高于正常人对照组 (0 % ,χ2 值和P值分别是 χ2 =7.85 4 ,0 .0 10 >P >0 .0 0 5和 χ2 =6 .6 89,0 .0 10 >P >0 .0 0 5 )。结论　胸血自体回输不会增加心胸创伤患者产生ACMA的危险性     

Clinical efficacy of postoperative autologous transfusion of filtered shed blood in hip and knee arthroplasty

BACKGROUND: Total knee arthroplasty (TKA) or total hip arthroplasty (THA) regularly results in postoperative requirement of blood transfusion. Because of the disadvantages of allogeneic blood transfusion (ABT) such as the risk of transfusion-associated infections, incompatibility-related transfusion fatalities, or immunomodulatory effects, a continuing effort to reduce allogeneic blood transfusion is important. For this purpose, the effect of reinfusion of drain blood, via a postoperative wound drainage and reinfusion system, on the need for allogeneic blood transfusion was evaluated. STUDY DESIGN AND METHODS: Using a prospective observational quality assessment design, we compared 135 patients scheduled for TKA or THA with a historic group of 96 patients. In the study group the Bellovac ABT autotransfusion system was used. The shed blood was returned either when 500 mL were collected or at most 6 hours after surgery. Compared were the preoperative, postoperative, and discharge hemoglobin, as well as the number of allogeneic blood transfusions. RESULTS: There were no statistical differences between preoperative, postoperative, and discharge hemoglobin levels. Autologous transfusion reduced the number of patients receiving ABT overall from 35 percent (control) to 22 percent (study). The decrease of allogeneic transfusion requirement was most significant after TKA: from 18 percent to 6 percent (p < 0.001). CONCLUSION: We conclude that the Bellovac ABT device reduces allogeneic blood transfusions in TKA and THA.     

自体血液回输对脊柱手术病人血常规的影响

目的 :探讨脊柱前路手术中自体血液回输对血常规的影响 ,评估其临床应用的安全性。方法 :脊柱前路手术患者 4 5例分为两组 ,Ⅰ组 :自体血液回输组 (n =2 7) ,Ⅱ组 :非自体血液回输组 (n =18)。对两组病人术前、术后第1天、第 7天的血常规进行观测。结果 :两组术后血常规变化规律一致 ;分别比较术前、术后第 1天、第 7天两组间血常规 ,均无显著性差异。组内白细胞 (WBC)计数、中性粒细胞含量 (neut% )在术后有一过性显著增高 (自体血液回输组为P <0 .0 1,异体血输入组为P <0 .0 5 ) ,术后第 7天两组均恢复正常 (P >0 .0 5 )。红细胞 (RBC)计数、血红蛋白含量 (Hgb)、红细胞比积 (Hct)均较术前有显著降低 (P <0 .0 5 )。未发现应用自体血液回输出现并发症。结论 :自体血液回输仅对血小板有破坏、清除 ,对其他血液成分无明显影响。     

Efficacy of leukocyte depletion of residual pump blood

In this study, we examined whether leukocyte depletion from the residual heart-lung machine blood at the end of cardiopulmonary bypass (CPB) has an effect on the leukocyte counts in the systemic circulation. Twenty-six patients undergoing coronary artery bypass grafting (CABG) were randomly allocated to a leukocyte-depletion group or a control group. In the leukocyte-depletion group (n = 13), all residual blood (400 mL to 1.4 L) was filtered by leukocyte-removal filters (Pall RS01) and reinfused to the patient after CPB, whereas, in the control group, an identical amount of residual blood after bypass was reinfused without filtration (n = 13). Leukocyte-depleted allogeneic blood was transfused if needed. Preoperative risk profiles, pump support and duration of aortic crossclamping time were identical in both patient groups (ns). Leukocyte depletion removed more than 96% of leukocytes from the residual retransfused blood (p < 0.01) and significantly reduced circulating leukocytes (p < 0.05) compared with the control group. Remarkably, lower numbers of circulating leukocytes were found, not at 1 hour after reinfusion, but at 4 and 8 hours after reinfusion (p < 0.05). There were no statistical differences between the two groups with respect to postoperative blood loss, the number of transfused packed red cells and mechanical ventilation time. These results show that leukocytes can be removed from the residual blood of the heart-lung machine after CPB very effectively. Furthermore, this leukocyte depletion results in a long-term effect, the clinical significance of which has to be elucidated in ongoing studies.     

Plasticizers excreted in urine: indication of autologous blood transfusion in sports

BACKGROUND: Misuse of autologous blood transfusions in sports remains undetectable. The metabolites of the plasticizer di‐(2‐ethylhexyl)phthalate (DEHP) were recently proposed as markers of blood transfusion, based on high urinary concentrations of these compounds observed in patients subjected to blood transfusion. This study evaluates DEHP metabolites in urine for detecting autologous blood transfusion. STUDY DESIGN AND METHODS: One blood bag was drawn from moderately trained subjects and the red blood cells (RBCs) were reinfused after different storage periods. Group 1 (12 subjects) was reinfused after 14 days, and Group 2 (13 subjects), after 28 days of storage. Urine samples were collected before and after reinfusion for determination of the concentrations of three DEHP metabolites, mono‐(2‐ethylhexyl)phthalate, mono‐(2‐ethyl‐5‐hydroxyhexyl)phthalate, and mono‐(2‐ethyl‐5‐oxohexyl)phthalate. RESULTS: Concentrations of DEHP metabolites on the days before reinfusion were in agreement with those described after common environmental exposure. A few hours after the reinfusion a significant increase was observed for all metabolites in all volunteers. Concentrations 1 day later were still higher (p < 0.05) than before reinfusion. Variations in urine dilution supported normalization by specific gravity. Concentrations of DEHP metabolites tended to be higher after longer storage times of RBCs. CONCLUSION: Autologous transfusion with RBCs stored in plastic bags provokes an acute increase in the urinary concentrations of DEHP metabolites, allowing the detection of this doping malpractice. The window of detection is approximately 2 days. The method might be applied to urine samples submitted for antidoping testing.     

Intraoperative reinfusion of erythrocyte mass in neuroanesthesiology

Automated reinfusion of autoerythrocytes prepared from blood lost during removal of tumors was the main component of transfusion therapy in 49 patients (52 operations) with brain tumors. All patients developed massive blood loss of 0.5-5 TCB during the intervention, reinfusion device cell saver C.A.T.S 2-02 (Fresenius, Germany) was used. Various aspects of clinical application of this method are discussed, its efficiency and factors affecting it are analyzed. Special attention is paid to time course of hemostasis values during automated reinfusion and the problem of tumor contamination of reinfused suspension. This latter problem was solved by using the last-generation leukocyte filter RC-400 Klev (Pall, Germany). Automated reinfusion of autoerythromass effectively compensated for massive intraoperative blood loss, on condition of correction of hemostasis disorders by fresh frozen plasma and purification of reinfused suspension from tumor cells by filtering through leukocytic filters. Moreover, our results indicate that utilization of cell saver is obligatory for some patients with supermassive hemorrhages.     

Tranexamic acid reduces blood transfusion in total knee arthroplasty even when a blood conservation program is applied

BACKGROUND: In total knee arthroplasty surgery, a blood conservation program is applied as a normal clinical practice to avoid allogenic transfusions. The objective of this study was to assess the effectiveness of tranexamic acid to reduce transfusions in total knee replacement even when a blood conservation program is applied. STUDY DESIGN AND METHODS: In a double-blind prospective study the patients scheduled for total knee arthroplasty were included in a well-established blood conservation program and then randomly assigned into two groups: In tranexamic acid group, 10 mg per kg ev bolus followed by 1 mg per kg per hour perfusion was administered, while in the control group, saline was given matching the protocol. RESULTS: Ninety-five patients were included (tranexamic acid group, 46; control group, 49). Thirty-three patients (34.7%) underwent preoperative procedures to reduce transfusions: presurgical autologous blood donation (12), recombinant erythropoietin (6), and elementary iron (15); postoperative drain for reinfusion was allocated in all the cases. Total blood loss on the fourth postoperative day was [mean (+/-SD)] 1744 (+/-804) mL in controls compared with 1301 (+/-621) mL in the tranexamic acid group (p < 0.05). Eleven units of blood were transfused (6 patients) in the control group versus one in the tranexamic acid group (p < 0.05). Only 2 patients (4%) in the tranexamic acid group received reinfusion of blood recovered by drains compared with 36 (73%) in the control group (p < 0.0001). No thromboembolic complications were detected. CONCLUSION: Tranexamic acid reduces blood losses and transfusion requirements even when a blood conservation program was used and it questions the usefulness of the postoperative reinfusion drains.     

抗凝剂及放置时间对静脉血常规测定的影响

目的了解肝素、乙二胺四乙酸二钾(EDTA-K2)抗凝剂及放置时间对于血常规白细胞计数(WBC)、红细胞计数(RBC)、血红蛋白(Hb)、血细胞比容(Hct)、血小板计数(PLT)的影响。方法分别取静脉血经肝素、EDTA-K2抗凝,于即刻,0.5、1、2、3、4、5、6、12h在MET(迈瑞)BC5500血细胞分析仪上以全血模式检测WBC、RBC、Hb、Hct和PLT。结果 WBC在3h内与EDTA-K2抗凝的静脉血即刻结果相比较,差异无统计学意义(P>0.05);RBC在6h内与EDTA-K2抗凝的静脉血即刻结果相比较,差异无统计学意义(P>0.05),在12h内,以肝素抗凝的静脉血与EDTA-K2抗凝的静脉血即刻结果相比较,差异无统计学意义(P>0.05);Hb在12h内与EDTA-K2抗凝的静脉血即刻结果相比较,差异无统计学意义(P>0.05);Hct在即刻以肝素抗凝的静脉血与EDTA-K2抗凝的静脉血即刻结果相比较,差异无统计学意义(P>0.05),而6h内与EDTA-K2抗凝的静脉血即刻结果相比较,差异无统计学意义(P>0.05);PLT在1h内与EDTA-K2抗凝的静脉血即刻结果相比较,差异无统计学...     

Washing of drained blood does not alter immediate immune effects of retransfusion

BACKGROUND: Retransfusion of postoperatively drained wound blood may be associated with adverse immune effects induced by many mediators present in unwashed filtered blood. STUDY DESIGN AND METHODS: In this randomized trial, the hypothesis that a washing procedure alters the course of markers of immune and inflammatory responses after retransfusion of blood collected from patients after endoprosthetic surgery is tested. Mean volume of blood reinfused was 363 ± 173 mL in Group A and 352 ± 180 mL in Group B. Five hours postoperatively patients either received washed (Group A) or unwashed (Group B) blood collected during the postoperative period. Circulating cytokines (tumor necrosis factor [TNF]‐α, interleukin [IL]‐6, IL‐8, IL‐10, monocyte chemoattractant protein [MCP]‐1) and lipopolysaccharide (LPS)‐stimulated TNF‐α secretion were measured at several time points pre‐ and postoperatively. RESULTS: IL‐6 and IL‐8 slightly increased immediately after retransfusion in both groups (by 48 ± 37 and 5 ± 2 pg/mL, respectively, in Group A; by 74 ± 60 and 17 ± 13 pg/mL in Group B). IL‐10 and MCP‐1 were unaltered and both circulating TNF‐α and LPS stimulated capacity in TNF‐α secretion decreased (by 5 ± 13 and 1 ± 31 pg/mL, respectively, in Group A; by 3 ± 14 and 29 ± 39 pg/mL in Group B), independent from a washing procedure. CONCLUSION: For small reinfusion volumes a washing procedure does not alter the ex vivo capacity of LPS induced TNF‐α secretion and the selected cytokine profile after retransfusion of postoperatively drained and filtered blood.     

Early treatment with ACTH-(1-24) in a rat model of hemorrhagic shock prolongs survival and extends the time-limit for blood reinfusion to be effective

The ability of ACTH-(1-24) to prolong survival and to extend the deadline for effective blood reinfusion has been studied in a model of lethal hypovolemic shock in the rat. Anesthetized rats were bled to a mean arterial pressure of 18 to 25 mm Hg and then subjected to one of the following iv treatments: a) saline; b) ACTH-(1-24), 160 micrograms/kg; c) blood reinfusion; d) ACTH-(1-24), 160 micrograms/kg; c) blood reinfusion; d) ACTH-(1-24), with saline 5 min after bleeding died within 0.05 h. On the other hand, the treatment with ACTH-(1-24) induced an almost complete and sustained recovery of cardiovascular and respiratory functions associated with a survival time of 44 +/- 18 h, while four of six rats reinfused with the withdrawn blood were still alive 15 days later. The time-lapse between bleeding and treatment was of crucial importance, and neither ACTH-(1-24) injection nor blood reinfusion had any effect if performed 25 min after bleeding. However, treatment with ACTH-(1-24) shortly after bleeding (5 min) greatly improved the effect of a later blood reinfusion. These data indicate that ACTH-(1-24) can prolong survival and permit the time-lapse between blood loss and blood reinfusion to be extended.     

剖宫产手术中不同时间应用抗生素对住院、用药时间及恢复状况的影响

目的探讨剖宫产手术中不同时间应用抗生素对住院、用药时间及恢复状况的影响。方法选择本院2018年2月至2019年2月收诊的105例剖宫产产妇作为研究对象,按照应用抗生素时间的不同分为观察组(术前+术后6 h)、对照组(术中+术后6 h)与常规组(术后即刻+术后6 h),各35例。比较三组产妇的住院情况、用药前、后炎症因子水平、感染情况与体温,并观察三组新生儿的发病情况。结果观察组的住院天数短于对照组及常规组,医疗费用均低于对照组及常规组,且对照组优于常规组(P<0.05)。用药后,三组的WBC、CRP、PCT水平均低于用药前(P<0.05);用药后,观察组的WBC、CRP、PCT水平均低于对照组及常规组,且对照组低于常规组(P<0.05)。观察组与对照组的泌尿系统感染、产褥感染、腹部切口感染、体温连续24 h≥38℃的发生率均低于常规组(P<0.05)。观察组与对照组新生儿的热病、高胆红素血症发生率均低于常规组(P<0.05)。结论术前、术后应用同等剂量的抗生素可有效改善剖宫产产妇的母婴结局、降低炎症因子水平并缩短产妇的恢复时间,值得推广使用。