机血回输对体外循环心内手术患者凝血功能的影响  

Effect of Direct Blood Re-transfusion on Coagulation in Patients Undergoing Open Heart Surgery with Cardiopulmonary Bypass

作　　者：银世杰[1] 黄海清[1] 

机构地区：[1]广西医科大学第一附属医院心血管病研究所手术麻醉科,南宁市530021

出　　处：《广西医学》2010年第12期1481-1485,共5页Guangxi Medical Journal

基　　金：广西医药卫生科学研究基金(桂卫科Z2004141)

摘　　要：目的探讨机血直接回输对体外循环(CPB)心内手术患者凝血功能的影响。方法 60例体外循环心内手术患者随机分成两组,A组30例,机血全部直接回输;B组30例,机血全部丢弃。对比两组患者切皮前即刻(T1)、给鱼精蛋白10 min后(T2)、关胸即刻(T3)、术后4 h(T4)采血测定血小板计数(PLT)、血浆游离Ca2+、血浆凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、凝血酶时间(TT)、纤维蛋白原(FIB)、D-二聚体(D-D)含量、活化凝血酶原时间(ACT)、血红蛋白(Hb)等指标的变化,并记录术中、术后24 h库血的用量和术后24 h胸腔引流量等临床情况。结果 PLT计数、血浆游离Ca2+、PT、APTT、TT、FIB、D-D、ACT、Hb在各时间点测定值两组间比较差异均无统计学意义(P>0.05)。A组库血用量少于B组(P<0.05)。术后24 h胸腔引流量两组间比较差异无统计学意义(P>0.05)。结论体外循环后直接回输机血不加重凝血功能紊乱,体外循环后采用机血直接回输的方法,能明显减少异体输血量。Objective To investigate the effect of direct blood re-transfusion on coagulation in patients undergoing open heart surgery with cardiopulmonary bypass（CPB）.Methods 60 patients with heart disease were collected randomly and divided into group A（direct blood re-transfusion,n=30）and group B（n=30 blood discarded）,blood samples were taken from jugular vein to assay platelet count（PLT）,plasma free Ca2＋,prothrombin time（PT）,activated partial thromboplastin time（APTT）,thrombin time（TT）,fibrinogen（FIB）,D-dimer（D-D）levels,activated prothrombin time（ACT）,plasma protein（Hb）and other indicators of change before skin incision（T1）,10 minutes after heparin neutralization by protamine（T2）,immediately closed chest（T3）,3-5 hours after operation（T4）four time points,the amount of banked blood and 24 hours mediastinal chest tube drainage was recorded.Results The measured values of PLT counts,plasma free Ca2＋,PT,APTT,TT,FIB,D-D,ACT,Hb at each time point were not statistically significant between the two groups（P〉0.05）.The amount of homologous transfusion of group A was significantly less than that of group B（P〈0.05）.24 hours mediastinal chest tube drainage was not statistically significant between the two groups（P〉0.05）.Conclusion Direct blood re-transfusion after cardiopulmonary bypass does not increase blood clotting disorder.Homologous blood transfusion in open heart surgery with cardiopuhnonary bypass can be obviously reduced by using direct blood re-transfusion method.

关 键 词：机血回输 凝血功能 体外循环 心内手术 

分 类 号：R654.1[医药卫生—外科学]