不用库血的体外循环心脏手术(附49例报告)  

No Homologous Blood Transfusion in Cardiac Surgery

作　　者：王小雷[1,2] 邓硕曾[1,2] 张东升[1,2] 姚滨 翟宇佳[1,2] 李再男 刘晓峰[1,2] 王辉 

机构地区：[1]广东省深圳市孙逸仙心血管医院麻醉科 [2]中国医学科学院中国协和医科大学心血管病研究所阜外心血管病医院麻醉科

出　　处：《中国循环杂志》1997年第2期94-96,共3页Chinese Circulation Journal

摘　　要：目的：采用综合措施开展血液保护，围术期不输异体血及血液制品，避免因输库血而感染肝炎等疾病。方法：选择术前血红蛋白≥１１７ｇ／Ｌ、血细胞比容≥０．３５、无肝炎病史或携带病毒的心脏病患者。手术开始时，即在适宜的麻醉深度下，实施控制性降压，给硝酸甘油２～３μｇ／ｋｇ，术者认真止血，术中进行血液稀释，转机后即刻按１５～１８ｍｌ／ｋｇ采集自体血，预充液中一次性加入抑肽酶，成人２００万ｋＩＵ，儿童１００万ｋＩＵ，转流后机器血全回输，每回输１００ｍｌ机器血补给鱼精蛋白５ｍｇ，体重小于２０ｋｇ者，转流后期加用人工肾超滤，将血液浓缩后回输。术野采用含有三磷酸腺苷８０ｍｇ的温生理盐水１００ｍｌ浸泡５分钟等措施。结果：４９例围术期未输异体血液及血制品。术后当日血红蛋白≥１１２ｇ／Ｌ，血细胞比容≥０．３４。术后１０日血红蛋白≥１１８ｇ／Ｌ，血细胞比容≥０．３４。术后２４小时人均纵隔心包引流量为３０～３２ｍｌ／ｋｇ，引流液血红蛋白为１５～２５ｇ／Ｌ。结论：用综合措施开展血液保护，不失为一安全、可行、有效的方法，既节省了费用又避免了输库血而感染肝炎等疾病。Objective:The techniques of blood conservation were used to protect patients from infectious diseases transmitted by perioperative homologous transfusion. Methods:Forty nine patients,with hemoglobin more than 117 g/L and hematocrit 0.35,undergoing open heart surgery with cardiopulmonary bypass(CPB)were primed without homologous blood.After the start of operation,a deliberated hypotension was performed under an appropriate depth of anesthesia. A dose of 2—3 μg/kg of nitroglycerin was used whenever necessary.Bleeding was carefully treated.At the begining of CPB,venous blood was collected(15—18 ml/kg)and diluted with crystalloid solution containing aprotinin(2,000,000 kIU in adult,1,000,000 kIU in childand 500,000 kIU in infant),which was all autotransfused with protamine(5 mg/100 ml)to patients after CPB. Results:All the patients did not use homologous whole blood,plasma,red blood cell or platelet perioperatively.On the day after surgery,their hemoglobin was ≥112 g/L and hematocrit ≥0 34,and were up to ≥118 g/L and ≥0.34,respectively in ten days.At the first 24 hours after surgery,the mean blood lost through mediastinal drainage was 30—32 ml/kg,with hemoglobin of 15—25 g/L.All patients were successfully operated with no complication and discharged from hospital at two weeks after surgery. Conclusion:The techniques of blood conservation were safe and effective in open heart surgery,which might not only save the bank blood but also avoid the possible risks from homologous blood transfusion.

关 键 词：血液保护 麻醉 心脏外科手术 体外循环 

分 类 号：R654.1[医药卫生—外科学]