33例心内直视手术不用库血的体会  

No Homologous Blood Transfusion in Open Cardiac Surgery of 33 Cases

作　　者：李惠君[1] 吕民[1] 田晶[1] 江萍[1] 林士平[1] 王伯杰[1] 

机构地区：[1]吉林省人民医院心脏外科

出　　处：《中国循环杂志》1998年第6期364-365,共2页Chinese Circulation Journal

摘　　要：目的：采用综合方法进行血液保护，以期在心内直视手术中不用库血，从而避免感染输血性疾病。方法：综合方法包括①适宜的麻醉深度，避免术中血压过高；②术前经桡动脉或腔静脉放出自体血贮存，放血量为１０～１５ｍｌ／ｋｇ；③术中应用抑肽酶或止血芳酸。抑肽酶总量成人为４００万ｋＩＵ，儿童为２００万ｋＩＵ。止血芳酸用量为４０ｍｇ／ｋｇ；④转流后机器血全部回输，每输１００ｍｌ机器血补给鱼精蛋白５～１０ｍｇ，同时加强利尿，浓缩血液；⑤术中认真止血，术野局部用三磷酸腺苷浸泡。结果：３３例患者，当术后血红蛋白超过９０ｇ／Ｌ，血细胞比容大于０．３０时，围术期可不用库血。术后２４小时引流总量为３２～４１０ｍｌ，平均２０６ｍｌ。出院时血红蛋白均超过１１０ｇ／Ｌ，而血细胞比容大于０．４０。结论：行心脏直视手术患者，术中用综合方法行血液保护。Objective:The techniques of blood conservation were used to protect patients from infectious diseases transmitted by perioperative homologous transfusion. Methods:The methodes were①An appropriate depth of anesthesia,hypotension was avoided;②The blood was collected(10—15 ml/kg)from artery or venous;③To used aprotinin(4 000 000 kIU in adult,2 000 000 kIU in children) and tranexamic(total 40 mg/kg);④After CPB,all autotransfused was used with protamine(5—10 mg/100 ml)to patients;⑤Bleeding was carefully treated and used ATP in open cardiac. Results:When hemoglobin was >90 g/L and hematocric>0.30,homologous blood was not used in 33 cases patients after operation.The blood lost through mediastinal drainage was 32—410 ml the mean was 206 ml.When all patients out hospital,hemoglobin was >110 g/L and hematocrit>0.40. Conclusion:The techniques of blood conservation were used to the patients of open cardiac surgery,did not use homologous blood.

关 键 词：血液保护 心内直视手术 自体输血 不用库血 

分 类 号：R654.1[医药卫生—外科学]