急性等容性血液稀释联合自体血回输对心脏瓣膜置换术患者血气指标凝血功能及输血并发症的影响

doi:10.3969/j.issn.1006-6233.2021.02.025

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摘要 目的: 探讨急性等容性血液稀释(ANH)联合自体血回输对心脏瓣膜置换术患者血气指标、凝血功能及输血并发症的影响。方法: 选取2018年1月至2019年1月于攀枝花市中心医院行心脏瓣膜置换术患者102例为研究对象,简单随机数字表法随机分为观察组、对照组,每组51例。对照组患者回输未经处理剩余库血或机血,观察组患者行ANH联合自体血回输。分别于血液稀释前,手术结束后15min、24h,48h记录各时段血气指标、凝血功能指标,并记录手术时间、术中出血量、胸引管引流量、补液量、异体血输注量、住院时间及术后1d内的输血并发症。结果: 两组患者的手术时间、术中出血量、补液量、住院时间等比较,差异无统计学意义(P>0.05),观察组患者的胸引管引流量、异体血输注量均明显少于对照组患者,差异具有统计学意义(P<0.05)。两组患者的PvO₂、PvCO₂、Fib水平均呈先降低后升高趋势,而PT、APTT、TT水平均呈先升高后降低趋势,组内各时点间比较差异具有统计学意义(P<0.05),除血液稀释前外,各时点组间比较差异具有统计学意义(P<0.05);两组患者的PH水平组内各时点、各时点组间比较差异均无统计学意义(P>0.05)。观察组患者的输血并发症发生率低于对照组患者,但组间比较差异无统计学意义(P>0.05)。结论: 急性等容性血液稀释联合自体血回输对心脏瓣膜置换术患者血气指标、凝血功能影响较小,可明显减少输注异体血量和输血不良反应,两者联合使用能更加有效的保护血液,是一种安全有效的输血方式。

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	张帮健
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关键词 ：急性等容性血液稀释, 自体血回输, 心脏瓣膜置换术, 血气分析, 凝血功能, 输血并发症

Abstract：Objective: To explore the effect of acute isovolumetric hemodilution (ANH) combined with autologous blood transfusion on blood gas indexes, coagulation function and blood transfusion complications in patients undergoing heart valve replacement surgery. Methods: 102 patients who underwent heart valve replacement in Panzhihua Central Hospital from January 2018 to January 2019 were selected as the research objects. The simple random number table method was randomly divided into observation group and control group, with 51 cases in each group. The patients in the control group were transfused with untreated remaining bank blood or machine blood, and the patients in the observation group were transfused with ANH combined with autologous blood. Before blood dilution, 15min, 24h, 48h after the end of the operation, record the blood gas index and coagulation function index at each time period, and record the operation time, intraoperative blood loss, chest drainage volume, fluid replacement volume, allogeneic blood transfusion volume, hospitalization Time and complications of blood transfusion within 1 day after operation. Results: There was no statistically significant difference in the operation time, intraoperative blood loss, fluid supplementation, and hospital stay between the two groups of patients (P>0.05). The observation group had significantly less chest drainage and allogeneic blood transfusion. In the control group, the difference was statistically significant (P<0.05). The PvO₂, PvCO₂, and Fib levels of the two groups of patients decreased first and then increased, while the levels of PT, APTT, and TT increased first and then decreased. The differences between the time points within the group were statistically significant (P<0.05). Except before hemodilution, the differences between the groups at each time point were statistically significant (P<0.05); there were no statistically significant differences in the pH levels of the two groups at each time point in the group or between the time points. (P>0.05). The incidence of blood transfusion complications in the observation group was lower than that in the control group, but the difference between the groups was not statistically significant (P>0.05). Conclusion:Acute isovolumetric hemodilution combined with autologous blood reinfusion has little effect on blood gas indicators and coagulation function in patients undergoing heart valve replacement surgery. It can significantly reduce the volume of foreign blood transfusion and adverse blood transfusion reactions. The combination of the two can protect blood more effectively. It is a safe and effective way of blood transfusion.

Key words： Acute normovolemic hemodilution Autologous blood transfusion Heart valve replacement surgery Blood gas analysis Coagulation function Blood transfusion complication

基金资助:四川省攀枝花市市级科技计划项目和财政科技专项资金计划,(编号:2018CY-S-9)

引用本文:

张帮健, 刘义鑫, 韩清涛, 杨昶. 急性等容性血液稀释联合自体血回输对心脏瓣膜置换术患者血气指标凝血功能及输血并发症的影响[J]. 河北医学, 2021, 27(2): 292-297.
ZHANG Bangjian, LIU Yixin, HAN Qingtao, et al. Effects of Acute Normovolemic Hemodilution Combined with Autologous Blood Transfusion on Blood Gas Index Coagulation Function and Transfusion Complications in Patients Undergoing Cardiac Valve Replacement. HeBei Med, 2021, 27(2): 292-297.

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http://www.hbyxzzs.cn/CN/10.3969/j.issn.1006-6233.2021.02.025 或 http://www.hbyxzzs.cn/CN/Y2021/V27/I2/292

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