心脏手术患者大量输血后的血清电解质变化分析  

Electrolyte changes induced by massive transfusion in patients undergoing cardiac surgery

作　　者：陈旭升 杨永涛 CHEN Xusheng;YANG Yongtao(Department of Blood Transfusion,the First Affiliated Hospital of Tsinghua University,Beijing 100016,China)

机构地区：[1]清华大学第一附属医院输血科,北京100016

出　　处：《中国输血杂志》2022年第6期612-614,共3页Chinese Journal of Blood Transfusion

摘　　要：目的探讨心脏手术患者短期内大量输血(MT)后体内电解质浓度对输血相关并发症的影响。方法收集2018~2019年本院成人心脏手术76例,按其围术期输血量均分为大量输血(MT)组(输注红细胞量≥10 U/人)和对照组[输注红细胞量(0~1)U/人];分别于术中输血前与术后通过离子选择电极法(ISE)检测和NM-BAPTA比色法检测患者即刻血清中Na^(+)、K^(+)、Ca^(2+)浓度,应用t检验比较分析2组术中(输血)前与手术后血清中Na^(+)、K^(+)、Ca^(2+)浓度的变化。结果MT组和对照组各患者人口学特征、手术种类(数)具有可比性(P>0.05),以及术(输血)前血清Na^(+)、K^(+)、Ca^(2+)等电解质指标水平相似(P>0.05),且均在正常值范围;大量输血组与对照组手术(输血)后血清Na^(+)、K^(+)、Ca^(2+)的平均值(mmol/L)分别为:4.25±0.44 vs 4.01±0.53、2.31±0.12 vs 2.45±0.43、140.82±2.31 vs 146.44±4.35(P<0.05);对照组在术后血清K^(+)、Ca^(2+)略低于术前,Na^(+)略高于术前(P>0.05),且均在正常值区间。结论心脏手术患者大量输血后易发生电解质紊乱,围术期输血过程中及输血后应及时监测电解质浓度。Objective To investigate the effect of electrolyte concentration on transfusion related complications in patients undergoing cardiac surgery after short-term massive transfusion(MT).Methods Seventy-six cases of adult cardiac surgery in our hospital from January 2018 to December 2019 were collected.According to their perioperative blood transfusion units,they were divided into the massive blood transfusion group(red blood cell units≥10 U/person)and the control group[red blood cell units(0~1)U/person].The concentrations of Na^(+),K^(+)and Ca^(2+)ions in serum were detected by ISE(ion selective electrode method)and NM-BAPTA before and after intraoperative blood transfusion.The changes of Na^(+),K^(+)and Ca^(2+)ions in serum before and after intraoperative blood transfusion were analyzed and compared through T-test.Results There were 38 patients in the MT group and 38 in the control group,and the demographic variables and types of surgeries(number)of patients in the two groups were comparable(P>0.05).The serum K^(+),Ca^(2+)and Na^(+)before operation were similar(P>0.05),and within the normal range.The mean values of serum K^(+),Ca^(2+)and Na^(+)(mmol/l)in the massive blood transfusion group and the control after operation(blood transfusion)were 4.25±0.44 vs 4.01±0.53,2.31±0.12 vs 2.45±0.43,140.82±2.31 vs 146.44±4.35(P<0.05).In the control,the serum K^(+),and Ca^(2+)were slightly lower than those before operation,while the Na^(+)was slightly higher(all P>0.05),and all were within the normal range.Conclusion Patients undergoing cardiac surgery are prone to suffer electrolyte disorders after massive blood transfusion.Electrolyte concentration should be monitored in time during and after perioperative blood transfusion.

关 键 词：大量输血 心脏手术 血清电解质 输血并发症 手术愈合不良 

分 类 号：R446.111[医药卫生—诊断学] R457.1[医药卫生—临床医学] R654.2