经桡动脉采血在急性等容稀释自体输血中的临床应用  

Application of radial arterial blood collection in acute normovolemic hemodilution autologous blood transfusion

作　　者：曾金[1] 贾月姣[1] 徐文兴 韦新权 ZENG Jin;JIA Yuejiao;XU Wenxing;WEI Xinquan(Department of anesthesiology,the Liuzhou general hospital,Liuzhou 545006,Chin)

机构地区：[1]柳州市人民医院麻醉科,广西柳州545006

出　　处：《临床医药文献电子杂志》2018年第37期11-13,16,共4页Electronic Journal of Clinical Medical Literature

摘　　要：目的探讨经桡动脉采血用于急性等容稀释自体输血的安全性及其效果。方法将术中可能失血超过500 ml且具有急性等容稀释自体输血适应症的手术患者180例,男96例,女84例,年龄20～70(52±7.8)岁,体重50～81(62±11.5)kg。ASAⅠ或Ⅱ级。随机分为Ⅰ、Ⅱ、Ⅲ三组,每组各60例。Ⅰ组经左或右侧肘正中静脉采血,Ⅱ组经左或右侧颈内静脉采血,Ⅲ组经左或右侧桡动脉采血,I组为对照组,Ⅱ组和Ⅲ组为观察组。每组在采血前经静脉输注琥珀酰明胶注射液500 ml后,再采自体血400 ml,并在室温下保存,在手术结束前或采血4 h内回输患者体内。分别观察三组的患者在麻醉前(T_0)、麻醉后10 min采血即刻(T_1)、采血开始5 min(T_2)、采血15 min(T_3)、采血20 min(T_4)以及采血开始30 min(T_5)时MAP、HR、SpO_2以及BIS(脑电双频指数);观察三组采血前和采血后CVP之值;记录三种方法采血所需的时间。测定三种采血方法在采血前和采血结束时患者Hb的含量。观察各组在采血、输血后24小时不良反应的情况。结果三组患者在年龄、性别、体重以及手术种类组间比较均无明显的差异(P>0.05)。三组在T_0时点各组间比较MAP、HR及BIS之值均无明显的差异(P>0.05);三组组内比较在T0时点的MAP、HR及BIS之值明显高于其它各时点之值(P<0.05)。三组组间和组内的Sp O2和CVP比较均无明显的差异(P>0.05)。三组采血后Hb明显低于采血前(P<0.05)。Ⅲ组采血时间明显短于Ⅰ组和Ⅱ组(P<0.05);Ⅱ组采血时间明显短于Ⅰ组(P<0.05)。Ⅰ组有1例患者术后总胆红素和非结合胆红素轻度升高,3天恢复正常,三组其余患者未见输血其它并发症。结论经桡动脉采血用于急性等容自体输血的方法安全、可靠,采血时间短,无并发症的发生。Objective To evaluate the safety and effect of application of radial arterial blood collection in acute normovolemic hemodilution autologous blood transfusion. Methods One hundred and eighty ASA Ⅰ or Ⅱ patients were included 96 males and 84 females, aged from 20 to 70 years old, weighed from 50 to 81 kilograms, who could lose blood more than 500 millilitres during operation and were suitable for normovolemic hemodilution autologous blood transfusion. They were divided into three groups（Ⅰ, Ⅱ and Ⅲ） randomly, 60 patients in each group.Group Ⅰ, blood taken from left or right median cubital vein of the patients, was control group. Group Ⅱ and group Ⅲ were observation groups. Blood was taken from right or left jugular vein in group Ⅱ and taken from right or left radial artery of the patients in group Ⅲ. Patients were infused 500 ml succinylated gelatin injectim before 400 ml blood was taken from different veins of patients in three groups. Blood was preserved at room temperature and within four hours before infusion. MAP, HR, SpO_2 and BIS were observed at six different time points. Values of CVP, Hb and total time were also observed. The side effects were evaluated during infusion and 24 hours later. Results There was no signifi cant difference between the three groups in age, sex, weight and the sorts of operations（P〉0.05）. There was also no signifi cant difference between the three groups in MAP, HR and BIS at T_0（P〉0.05）. The values of MAP,HR and BIS were much higher at T_0 than that of other time points in each group（P〈0.05）. There was no signifi cant difference between the three groups in SpO_2 and CVP（P〉0.05）.The value of Hb was much lower after taking blood than that of ahead of taking blood（P〈0.05）. The time of taking blood in groups Ⅲ was much shorter than that of groups Ⅰ and group Ⅱ（P〈0.05）, which in group Ⅱ much shorter than that of in group I（P〈0.05）. There was no side effect autologous blood transfusion in three groups except for

关 键 词：急性等容稀释自体输血 采血方法 桡动脉 血液保护 

分 类 号：R614.1[医药卫生—麻醉学] R472.1[医药卫生—外科学]