瓣膜置换术后引流液血红蛋白含量变化指导自体血回收最佳时段的研究  

Clinical research on the optimum time interval of blood salvage guided by the trend of hemoglobin loss in shed mediastinal blood after valve replacement

作　　者：陈越岭[1] 郝兴海[1] 贾明[1] 侯晓彤[1] 车辑[1] 卢荣[1] 贾士杰[1] 

机构地区：[1]首都医科大学附属北京安贞医院-北京市心肺血管疾病研究所心外科危重症中心,100029

出　　处：《心肺血管病杂志》2016年第11期871-874,共4页Journal of Cardiovascular and Pulmonary Diseases

基　　金：北京市属医院科研培育项目(编号:PX2016004)

摘　　要：目的：观察瓣膜置换术后引流量和心包纵隔引流血中血红蛋白丢失量随时间变化的趋势,为有效回收利用术后心包纵隔引流血提供基础数据。方法：对2016年1月至2016年6月瓣膜置换术后早期引流量偏多的140例患者进行了前瞻性横断面研究,观察其24h内引流量及心包纵隔引流血中血红蛋白丢失量随时间变化的趋势。记录前10h每小时引流量,并采集引流血检测引流血中血红蛋白浓度（HB）,计算引流血中血红蛋白含量,即血红蛋白丢失量。结果：术后6h内引流量和血红蛋白丢失量分别达到24h总量的76%和85%。引流量、HB、血红蛋白丢失量均随时间逐渐下降,下降趋势在6~8h内非常明显,其后趋于缓和。结论：心脏术后心包纵隔引流血血红蛋白丢失量随时间迁延逐渐减少,前6h为24h总量的85%。瓣膜置换术后前6h是进行引流血自体回输的主要时段。Objective： This study was designed to observe the trend of hemoglobin loss in shed mediastinal blood and drainage volumes after valve replacement,and to provide the basic data for effective autotransfusion of shed mediastinal blood. Methods： We conducted a cross sectional observational study from January2016 to June 2016. One hundred and forty patients underwent valve replacement surgery who had a total sum of150 m L shed mediastinal blood in any 1 hour within the first 3 hours were included in this study. In the first 10 hours,drainage volumes were recorded every hour,and the hemoglobin concentrations of blood drainage were obtained through performing blood routine test every hour. We calculated the hemoglobin content in blood,which represented the loss of hemoglobin. Results： Shed mediastinal blood volumes within the 6 hours post operation contributed to 76% of the total drainage volumes in 24 hours. Loss of hemoglobin in the first 6 hours accounted for 85% of the total loss in the first day post operation. Drainage volumes,hemoglobin in shed mediastinal blood and loss of hemoglobin gradually decreased with time. The downward trend was quite obvious in the first 6 to 8 hours,and tended to ease afterwards. Conclusion： After cardiac surgery,hemoglobin loss in shed mediastinal blood decreased gradually with time. The loss of hemoglobin in the first 6 hours accounted for 85%of the total loss 24 hours post surgery. The first 6 hours after valve replacement was the proper time period to autotransfuse the shed mediastinal blood.

关 键 词：瓣膜置换术 心包纵隔引流血 自体回输 

分 类 号：R54[医药卫生—心血管疾病]