洗涤式自体血回输在心脏外科手术中的应用及护理

目的:探讨洗涤式自体血回输在心脏外科手术中的应用效果及护理方法.方法:对50例心脏手术患者术中进行自体血回输.术前做好心理护理及交叉配血,术中密切观察病情.分析患者手术前后血红蛋白(Hb)、红细胞压积(HCT)、血小板(PLT)、活化部分凝血酶时间(APTT)等指标变化情况.结果:本组50例患者均顺利手术,术中出血总量45 400 ml,自体血回输20 700 ml,均未发生自体血回输并发症.术后1例因迟发型心脏破裂死亡,2例因急性肾衰竭死亡.结论:洗涤式自体血液回输可有效减少心脏外科手术患者异体血输注,是一种经济、安全、实用的血液保护技术.     

加强手术室护理干预提高破裂腹主动脉瘤患者救治率

目的:探讨手术室护理干预在破裂腹主动脉瘤急救中的作用,提高破裂腹主动脉瘤患者救治率。方法:回顾性分析1999年4月至2007年6月期间我院收治的28例肾动脉下破裂腹主动脉瘤患者的临床资料,其中男20例,女8例;年龄35~78岁,平均65岁。所有患者均行急诊手术治疗。结果:28例破裂腹主动脉瘤患者手术全部成功,无一例术中死亡;术后30d内死亡10例,死亡率35.7%,死亡原因为出血性休克所致的急性肾功能衰竭4例、多器官功能衰竭3例、呼吸循环衰竭3例。结论:手术治疗是对破裂腹主动脉瘤急救的唯一有效治疗,加强手术室护理干预能够有效提高破裂腹主动脉瘤患者的救治率。     

腹腔内出血术中自体血回输112例分析

目的：探讨利用术中血液回收处理后回输给病人的临床效果和安全性。方法：回顾性分析对1995-2004年间本院112例腹腔内出血病人术中自体血回输患者的临床资料。结果：79例经自体血回输休克得以纠正。33例尚需补充部分异体血;回输后2例血尿,无死亡病例,未见其他不良反应。结论：自体血回输不仅节省异体血,而且可提高大出血时的抢救成功率,减少不必要的输血反应及并发症。     

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。     

孕妇腹腔内出血自血回输22例临床分析

目的　探讨自体输血抢救异位妊娠及卵巢黄体破裂发生的严重腹腔内出血的有效性。方法　对本院自1998年 1月～ 2 0 0 1年 12月收治且经手术证实腹腔内出血 6 8名孕妇作回顾性分析 :有 4 7例无自血回输禁忌 ,将其中采用自制简易自血回输装置于术中行自血回输的 2 2例作为自血回输组 ,将术中输异体血的 2 5例 (有 14例因行后穹窿穿刺放弃自体输血 )作对照组 ,对两组病例的腹腔出血量 ,输血量作观察、比较。结果　自血回输组的腹腔内出血量、平均输血量 (异体输血与自体输血之和 )虽高于对照组 ,而异体输血量明显降低。结论　自血回输可有效救治孕妇腹腔内出血 ,抢救病人快捷、安全 ,节约血源、降低患者医疗费用。     

异位妊娠术中自血直接回输146例报告

目的：观察异位妊娠术中自血直接回输的可行性及应用价值。方法：采用输液、输血(异体和自体血直接回输)、手术等方法治疗异位妊娠破裂患者146例。结果：146例均抢救成功，痊愈出院。结论：自血直接回输可有效救治异位妊娠腹腔内出血，抢救病人快捷、安全、有效，节约血源，降低患者医疗费用。     

腹主动脉瘤破裂患者的急救及护理对策

目的总结对腹主动脉瘤破裂患者的急救措施及护理对策。方法回顾分析2004年1月-2008年2月收治的11例腹主动脉瘤破裂患者抢救及护理过程。结果6例患者治愈出院,5例死亡,其中术中失血性休克死亡1例,术后消化道大出血及多功能器官衰竭死亡2例,放弃治疗出院后死亡2例,存活率为54．5％。结论通过对腹主动脉瘤破裂患者采取及时有效的抢救配合及护理措施,有效地提高了手术的成功率及生存率。     

34例异位妊娠破裂伴失血性休克术中自体血回输的临床应用

目的：探讨自体血回输在异位妊娠破裂伴失血性休克术中的临床应用价值。方法：我院2010-05-2012-05采用自体血液回输机对34例异位妊娠破裂伴失血性休克患者在术中进行自体血回输,分别记录术中出血量和回输血量。结果：34例患者共回收自体血52940ml,回输血32130ml,所有患者术后恢复良好,无相关并发症。结论：异位妊娠破裂伴失血性休克术中运用自体血回输安全,可快速获得新鲜红细胞,有效维持血容量,减少异体血的使用,降低输血并发症,提高抢救成功率。     

自体血液回收在脾破裂手术中的应用

目的观察脾破裂手术中应用血液回收机自体血液回输的临床效果．方法脾破裂手术中，用北京京精医疗设各公司生产的自体-2000型自体血液回收输机对12例脾破裂患者行自体血液回输，手术前后采静脉血行血常规，血生化检验．对术后患者恢复情况进行观察。结果术中平均每例回收726ml；术后血常规、血生化检查均正常，病人恢复顺利．结论脾破裂手术中应用自体血液回收技术，具有及时、高效、安全等特点，是一项值得推广的输血方法．     

自体血回输机在脾破裂抢救术中的应用体会

总结自体血回输机在脾破裂抢救术中的应用体会。脾破裂急诊手术中应用自体血回输机行自体血回输,操作方法简单,可缩短脾破裂患者急诊输血的等待时间,降低输血的风险,提高输血质量和紧急抢救成功率。     

Proactive administration of platelets and plasma for patients with a ruptured abdominal aortic aneurysm: evaluating a change in transfusion practice

BACKGROUND: Continued hemorrhage remains a major contributor of mortality in massively transfused patients and those who survive have a higher platelet (PLT) count and a shorter prothrombin time and activated partial thromboplastin time (APTT) than nonsurvivors. It was considered that early substitution with PLTs and fresh-frozen plasma (FFP) would prevent development of coagulopathy and thus improve survival. STUDY DESIGN AND METHODS: Survival of patients undergoing surgery for a ruptured abdominal aortic aneurysm (rAAA) was compared after implementing a proactive transfusion therapy encompassing two pooled buffy-coat PLT concentrates (PBPCs) immediately when a rupture of the aorta was suspected and again 30 minutes before aortic unclamping together with FFP administered in a 1:1 ratio to the amount of red blood cells (RBCs) with that of a control group receiving transfusion therapy according to existing recommendations. RESULTS: The intervention group (n = 50) had a higher PLT count at arrival at the intensive care unit compared to the control group (n = 82; 155 x 10(9)/L vs. 69 x 10(9)/L; p < 0.0001), shorter APTT (39 sec vs. 44 sec; p < 0.001), fewer postoperative transfusions (RBCs, 2 vs. 6; FFP, 2 vs. 4; and PBPCs, 0 vs. 1; p < 0.01), and a higher 30-day survival rate (66% vs. 44%; p = 0.02). CONCLUSION: This study suggests that proactive administration of PLTs and FFP improves coagulation competence, reduces postoperative hemorrhage, and increases survival in massively bleeding rAAA patients.     

自体输血在老年病人中的应用

目的 观察老年人术前自体输血的临床效果。方法 自决定施行自体输血之日起,入选病例每天口服多糖铁150mg Bid。采血前1小时按预采血量的3倍给予晶、胶体溶液(晶、胶体溶液量比例为2：1),经外周静脉输入,然后经另一侧静脉采血,每次采血400ml,间隔72小时采血1次,总采血量不应超过1200ml。结果 除2例病人因术中失血量过多同时输注异体血以外,其余患者均未用异体血,术后恢复良好。结论 只要患者Hb、Hct、Plt在正常范围内,无严重心、肺疾患,在老年病人中开展自体输血是安全有效的。     

The role of the pedicle omental flap in ruptured abdominal aortic aneurysm: a case report and literature review

A ruptured infrarenal abdominal aortic aneurysm (rAAA) is associated with an in-hospital mortality rate of 40% and an overall mortality rate of 60–80%. Open surgical repair for rAAA remains the principal method of treatment when endovascular repair is not available. Graft infection occurs in 1–4% of patients at 5 years, with a high incidence following emergency treatment. Other graft-related complications include pseudoaneurysm, graft occlusion and aorto-enteric fistula. This case report describes a 66-year-old male patient that was admitted to hospital complaining of intense abdominal pain, low blood pressure and tachycardia. He was diagnosed with a rAAA and treated using segmental resection of the abdominal aorta followed by reconstruction with a synthetic Dacron prosthesis. A pedicle omental flap was wrapped around the prosthetic graft and it was also used to fill the retroperitoneal cavity in order to reduce the risk of graft-related complications. Computed tomography angiography after 6 months showed good integration of the aortic prosthetic graft and the viability of the omental flap. In our opinion, vascular surgeons should consider the pedicle omental flap when they perform open surgical repair for rAAA in order to reduce the incidence of graft-related complications.     

心脏瓣膜置换术患者应用改良贮存式自体输血和异体输血的效果比较

目的 对比改良贮存式自体输血和异体输血对心脏外科瓣膜置换术患者手术及术后恢复的影响,确定改良贮存式自体输血采血法在心脏外科手术中应用的效果.方法 选取2013年1～5月本院行心脏瓣膜置换术的择期手术患者200例,其中使用改良贮存式自体输血采血法进行术前自体备血的患者100例,年龄21～73岁,心功能分级Ⅱ～Ⅲ级,采血前平均Hb为（147.34＆#177;12.69） g/L,Hct为（43.41土3.72）％;使用异体血术前备血的患者100例,年龄18～71岁,心功能分级Ⅱ～Ⅲ级,术前平均Hb为（133.93＆#177;25.94） g/L,Hct为（38.24＆#177;9.41）％,对比两组患者在围术期各项指标的差异.结果 100例改良贮存式自体输血组使用血液总量319U,100例输注异体血组使用血液655U,两者相比,自体输血组手术血液使用总量、平均异体红细胞量、平均异体血浆量均明显降低（P＜0.05）.自体输血组采血后血红蛋白浓度、红细胞压积轻度降低,但在正常范围内.术后1d血红蛋白浓度及红细胞压积均明显高于异体输血组患者,差异具有统计学意义（P＜0.05）.出院前血红蛋白浓度、红细胞压积两组患者比较差异不明显;自体输血组患者术后到出院的平均时间为（6.58＆#177;1.9）d,异体输血组患者为（10.01＆#177;3.87）d,差异有统计学意义（P＜0.05）.使用改良贮存式自体输血的患者术后未发生感染,而异体输血组患者术后感染率为3％.同时自体输血组患者的住院成本明显降低（P＜0.05）.结论 改良贮存式自体输血采血法,较异体输血法对红细胞破坏少,血液输注量少,患者术后各项指标恢复快,感染率低,经济实用,可广泛应用于心脏外科瓣膜病等择期手术.     

弓上主动脉夹层的腔内隔绝治疗(附22例报告)

目的总结需进行主动脉弓上动脉重建、累及主动脉弓的Stanford B型主动脉夹层(以下简称B型夹层)的腔内隔绝治疗经验。方法 2001年10月—2009年3月我科对22例累及主动脉弓的B型夹层行腔内隔绝治疗,病变均累及距左锁骨下动脉开口15 mm内。根据夹层形态选择应用移植物开槽、移植物开窗、"烟囱"式分支支架置入和弓上杂交技术等治疗方式。出院后6～12个月进行第1次主动脉CT血管造影(CTA)随访,后每年进行CTA随访1次,研究终点为疾病进展、出现严重并发症或死亡。结果本组出现手术相关并发症2例。术后随访7.5～51.3个月,平均27.1个月。1例因左锁骨下动脉覆盖造成术后脑梗死,术后6 h行左颈外动脉-左椎动脉旁路手术,术后12 d死亡。1例2期手术后出现心肌梗死,于术后7 d死亡。应用移植物开槽技术的患者中,1例术后6个月出现左锁骨下动脉闭塞,但患者无相关缺血症状。在获得中、长期随访的20例中,所有旁路血管通畅、良好,无近端内漏或移植物移位,夹层假腔均出现血栓化,其中18例假腔直径缩小,平均缩小14.0 mm,另2例假腔直径无变化。结论对累及主动脉弓的B型夹层,腔内隔绝手术是行之有效的。     

Aortic dissection.

Aortic dissection, once thought to be rare, is the most common catastrophe of the aorta, being twice as common as ruptured abdominal aortic aneurysm. In one Inner London borough, aortic dissection accounted for 4.2% of sudden deaths in men over a three-year period. Early diagnosis and prompt treatment are crucial to achieving a successful outcome, because the events that influence survival occur early in the course of the disease. Surgical repair of aortic dissection is an uncommon operation in the United Kingdom. The Cardiac Surgical Register for 1988 (the most recent year available for analysis) reveals that 208 operations were performed to replace the ascending aorta, 12 operations to replace the aortic arch and 15 operations on the descending aorta during that year.     

Autologous blood transfusion: The benefits to the patient undergoing abdominal aortic aneurysm repair

The clinical benefits of using intraoperative autologous blood transfusion during abdominal aortic aneurysm bypass surgery become increasingly apparent when use of autologous and homologous blood transfusions is compared. That homologous blood transfusions carry some risk is widely recognized. When autologous blood is used as a sole source of blood transfusion, the risk of transmission of infectious agents and potential immunologic side effects are avoided. A prospective randomized pilot study comparing autologous and homologous blood transfusion in patients undergoing elective infrarenal abdominal aortic aneurysm bypass surgery was undertaken. The purpose of this study was to determine whether autologous blood salvaged intraoperatively may serve as an alternative to homologous blood by comparing the rate of postoperative infection and duration of hospital stay for patients receiving autologous versus homologous blood transfusions. Fifty patients undergoing abdominal aortic aneurysm bypass surgery were prospectively randomly assigned to receive either a homologous or an autologous blood transfusion, with 27 receiving a homologous blood transfusion and 23 receiving an autologous blood transfusion. The data from this study show that the length of hospital stay of patients receiving an autologous blood transfusion intraoperatively was reduced by a mean of 3 days and the risk of postoperative complications, such as a systemic inflammatory response or sepsis, was reduced by more than 50%.     

Rupturierte abdominelle Aortenaneurysmen: Status quo nach einem Vierteljahrhundert Behandlungserfahrung

BACKGROUND: Postoperative mortality rates between 40% and 50% have been invariably reported for the treatment of ruptured abdominal aortic aneurysms (rAAA) over the last 50 years. The aim of this analysis was to investigate which patient subgroups benefit from open surgery and in which subgroups a change of treatment strategies should be considered due to lack of improvement despite optimal patient management. PATIENTS AND METHODS: From 1980 to 2002 a total of 230 patients underwent surgery because of a ruptured AAA. The observation period was divided into 3 intervals to achieve an approximately equal distribution of patients. The effect of the observation period and of baseline parameters on mortality rates were investigated. RESULTS: Between 1980 and 1990, 72 patients were operated with a mortality rate of 38.9% (n = 28). During the second period (1991-1996) surgery was performed in 72 patients with a mortality rate of 40.3% (n = 29). In the third observation interval (1997-2002) 86 patients underwent surgery with an unvaried high mortality rate of 40.7% (n = 35). By applying a logistic regression model including age, gender, modality of rupture, location of cross-clamping and type of operation, only the modality of rupture and the patient's age, which are uncontrollable by the surgeon, could be shown to have a significant impact. CONCLUSION: Summing up these findings, open surgical repair of rAAA only leads to acceptable results when performed in younger patients without supposed comorbidities. Survival appears to be accidental in patients with advanced age and increased prevalence of relevant comorbidities/underlying diseases. Minimally invasive techniques may offer promising treatment options to those patients, as they do in elective interventions.     

胸主动脉瘤破裂入左肺1例报告及文献分析

目的 对胸主动脉瘤破裂入左肺进行回顾性分析，旨在提高对胸主动脉瘤破裂入左肺的早期诊断和治疗的有效性。方法 结合1例报告，总结自1990年1月至2005年3月文献报道的胸主动脉瘤破裂入左肺16例病例。根据其有无感染、首发症状、胸主动脉瘤部位、侵入肺叶、手术方法及治疗效果进行分析。结果 胸主动脉瘤侵入左肺叶多数病程长，多合并肺部细菌和／或特异性感染，咯血是最常见的首发症状；来源于主动脉弓的瘤多侵入左肺上叶。手术多以全弓或次全弓切除及人工血管置换和左肺上叶切除术为主，而降主动脉瘤多侵入左肺下叶，手术以主动脉瘤切除及主动脉修补或血管置换术和左肺下叶切除为主；若无不可控制的大出血，预后较好。结论 胸主动脉瘤切除及人工血管置换术加侵入相应肺叶的切除术是治疗胸主动脉瘤侵入左肺的有效方法。     

适用于腔内隔绝移植物及血流动力学研究的犬肾周型腹主动脉瘤模型的建立

建立一种适用于研究腔内隔绝移植物及血流动力学的犬肾周型腹主动脉瘤模型。方法通过在犬近肾腹主动脉段移植经0.6%戊二醛浸泡30min去抗原处理后的牛颈外静脉,制作15例犬肾周型腹主动脉瘤模型。将此动脉瘤模型与患者的肾周型腹主动脉瘤进行形态学的相比,并且检测血流动力学参数并与15例腹主动瘤患者对比。结果15只动物手术过程顺利,术中死亡0只,术后1天腹腔出血死亡1只,术后2天急性肾衰死亡3只。动物模型与肾周型腹主动脉瘤患者动脉瘤形态相似。直径、壁厚的比例相似。瘤体内收缩压、舒张压、平均动脉压均高于肾上腹主动脉、髂总动脉和动脉瘤入、出口。动脉壁弹性相似。动脉瘤中都出现了涡流或湍流。结论此模型是适合肾周型腹主动脉瘤腔内隔绝移植物及血流动力学研究有较大实用坐和动物模型。