非体外循环冠状动脉搭桥术中自体血回收回输的应用研究  

Application of autotransfusion in off-pump coronary artery bypass grafting

作　　者：马会民[1] 白萍萍[1] 张连仲[1] 钱晓亮[1] 胡俊龙[1] 程兆云[1] Ma Huimin;Bai Pingping;Zhang Lianzhong;Qian Xiaoliang;Hu Junlong;Cheng Zhaoyun(Henan Provincial People’s Hospital,Zhengzhou 450003,China)

机构地区：[1]河南省人民医院,郑州450003

出　　处：《中国实用医刊》2020年第8期13-16,共4页Chinese Journal of Practical Medicine

基　　金：河南省科技厅基础研究计划项目(132300410408)。

摘　　要：目的观察非体外循环下冠状动脉搭桥术中自体血回收回输的应用效果。方法选取2016年1月至2018年5月河南省人民医院心脏外科录入中国心外科数据库(CCSR)接受非体外循环冠状动脉搭桥手术的152例患者随机分为两组。观察组术中使用自体血回收装置并回输(n=76);对照组术中未使用自体血回收装置并输注库存血(n=76),因术中被排除4例,实际对照组72例。统计两组患者术前和术后24 h时血红蛋白(Hb)、红细胞比容(Hct)、白细胞计数(WBC)、血小板计数(PLT)、凝血活酶时间(PT)、活化部分凝血酶时间(APTT)、术后24 h引流量、库血输注量、肺功能、肾功能等参数,比较分析两组患者的输血量、输血相关不良反应、肺功能、肾功能改变等。结果与对照组比较,观察组术中库血输注量减少,肺功能、肾功能等显著改变(P<0.05);与对照组比较,观察组术后第1天的血液指标比较差异均有统计学意义(P均<0.05)。观察组未发生输血相关性发热、过敏反应等,而对照组出现严重发热反应3例、过敏反应1例。结论在非体外循环冠状动脉搭桥术中自体血回收回输可明显减少异体血输注量和输血不良反应,肺功能、肾功能均得到更好保护,术后凝血及恢复情况与输注库存血患者无明显差异。Objective To observe the effect of autotransfusion during off-pump coronary artery bypass grafting.Methods A total of 152 patients from the China Cardiac Surgery Registry(CCSR)with coronary artery disease in Henan Provincial People’s Hospital from January 2016 to May 2018 was randomly divided into two groups.In observation group,autogenous blood recovery device was used and transfused(n=76);in control group,autogenous blood recovery device was not used and stored blood was transfused(n=76),4 cases were excluded during the operation,and 72 cases in the actual control group.The hemoglobin(Hb),hematocrit(Hct),leukocyte count(WBC),platelet count(PLT),thromboplastin time(PT),activated partial thromboplastin time(APTT),flow rate at 24 h after operation,blood volume,pulmonary function and renal function were measured,the blood transfusion volume,transfusion related adverse reactions,pulmonary function and renal function of the two groups were compared and analyzed.Results Compared with control group,the amount of blood transfusion in the observation group decreased,and the pulmonary function and renal function changed significantly(P<0.05);compared with control group,the blood indexes of the observation group on the first day after operation had statistical significance(P<0.05).There was no transfusion related fever or allergic reaction in observation group,while there were 3 cases of severe fever and 1 case of allergic reaction in the control group.Conclusions In off-pump coronary artery bypass grafting,autotransfusion can significantly reduce the volume of allogeneic blood transfusion and adverse reactions of transfusion,the pulmonary function and renal function were better protected.There was no significant difference in coagulation and recovery between the patients who received blood transfusion and the patients who received blood storage.

关 键 词：冠心病 非体外循环冠脉搭桥术 自体血回收 异体血 自体输血 

分 类 号：R65[医药卫生—外科学]