回收式自身输血技术在无血骨科手术中的价值  

The Value of Autotransfusion Technique in the Bloodless Orthopedic Surgery

作　　者：曹涛[1] 周媛[1] 范金波[1] 刘久波[1] 

机构地区：[1]十堰市太和医院.湖北医院学院附属医院输血科,湖北十堰442000

出　　处：《湖北医药学院学报》2017年第4期312-314,324,共4页Journal of Hubei University of Medicine

基　　金：湖北省卫生厅科研基金项目(WJ2015CB016)

摘　　要：目的:回顾性分析1 180例回收式自身输血技术在骨科手术中的应用情况,确认回收式自身输血技术在无血骨科手术中的价值,为更加安全、科学地将该血液保护技术推广至临床提供依据。方法:采集我院2015年3月-2017年3月间骨科手术中回收式自身输血登记表中的数据,对术前诊断和(或)手术方式、出血量、异体用血量、回收备用、清洗回输、回收总量、回输血量等进行回顾性分析。结果:1 180例骨科回收式自身输血中,骨关节病行关节置换术回输267例,回输总量75 884 m L(28.01%);肱骨、股骨等骨折切开复位内固定回输291例,回输总量67 449 m L(24.90%);颈椎、胸椎、腰椎疾病行椎管减压术回输389例,回输总量122 573 m L(45.25%);其他骨科手术回输14例,回输总量5 002 m L(1.84%);4组骨科数据中平均回输血量与平均出血量存在线性关系,占比约为36.50%(总回收率)。结论:在骨科择期手术中,一方面可以适当增加备用自体血的范围,还可以选择情况稍好的患者同时采用贮存式自体输血,最大化的减少异体血的用量,保障患者的权益;另一方面,根据设备的血液回收率可以大致估算出患者的出血量,回输血量/0.4(或0.33,均值0.365),即为患者术中出血量。Objective A retrospective analysis of 1 180 cases of recovery application of autotransfusion in the operation of orthopedic,surgery was performed to verify the value of autotransfusion of recovered blood during orthopedic surgery,thereby providing safer and scientifically meaningful techniques for clinical applications. Methods The related data were collected from recovery autotransfusion registration archives in our hospital from March 2015 to March 2017. A retrospective analysis was performed on the preoperative diagnosis,surgical methods,bleeding volume,the amount of allogeneic transfusion,recovery reserve volume,reinfusion,total recovery and blood transfusion volume. Results Of 1 180 patients who received orthopedic surgery and salvaged blood autotransfusion,267 cases with hip arthroplasty received transfusion amount of 75 844 m L（ 28.01%）,291 cases with open reduction and internal fixation for the humerus and femur fracture received transfusion amount of 67 449 m L（ 24.90%）,389 cases with vertebral canal decompression surgery for cervical,thoracic and lumber disease received transfusion amount of 122 573 m L（ 45. 25%）,and the other 14 cases with orthopedic surgery received transfusion amount of 5 002 m L（ 1.84%）. In the 4 groups＇ orthopedics data,there was a linear relationship between the average transfusion amount and the average bleeding amount,accounting for approximately 36. 50%（ total recovery rate）.Conclusion For the elective orthopedic surgery,on the one hand,the scope of spare autologous blood can be increased appropriately and predeposit autotransfusion can be used for some patients to maximize the reduction of allogeneic blood amount and protect patients＇ rights; on the other hand,based on the blood recovery rate generated by the equipment,the bleeding amount of the patients during operation can be roughly estimated as： the volume of blood transfusion/0.4（ or 0.33,mean 0. 365）.

关 键 词：回收式自身输血 血液保护 骨科手术 无血手术 

分 类 号：R457.1[医药卫生—治疗学] R687[医药卫生—临床医学]