不同自体输血方法在不停跳冠脉搭桥术后患者中的应用及对血氧代谢状况的影响  

Application of different autologous blood transfusion methods in patients after beating coronary artery bypass grafting and their effects on blood oxygen metabolism

作　　者：艾则孜·阿布力米提 艾来提·塔来提[2] 艾斯卡尔·沙比提[3] Aizezi·Abulimiti;Ailaiti·Talaiti;Aisikaer·Shabiti(Department of Blood Transfusion,Friendship Hospital,Urumqi,Xinjiang,Urumqi Xinjiang 830049,China;Department of Anesthesiology,The First Affiliated Hospital of Xinjiang Medical University,Urumqi Xinjiang 830011,China;Department of Cardiac Surgery,The First Affiliated Hospital of Xinjiang Medical University,Urumqi Xinjiang 830011,China.)

机构地区：[1]新疆乌鲁木齐市友谊医院输血科,新疆乌鲁木齐830049 [2]新疆医科大学第一附属医院麻醉科,新疆乌鲁木齐830011 [3]新疆医科大学第一附属医院心脏外科,新疆乌鲁木齐830011

出　　处：《临床和实验医学杂志》2022年第24期2654-2657,共4页Journal of Clinical and Experimental Medicine

基　　金：新疆维吾尔自治区自然科学基金资助项目(编号:20-11211-B33)。

摘　　要：目的 比较不同自体输血方法在不停跳冠脉搭桥术后患者中的应用及对血氧代谢状况的影响。方法 采用回顾性分析,选择2017年2月至2020年4月新疆医科大学第一附属医院麻醉中心收治的全身麻醉下行不停跳冠脉搭桥术的患者124例作为研究对象,根据随机信封抽签原则分为观察组与对照组,各62例。对照组给予异体血输注,观察组给予洗涤式自体血回输。记录两组患者手术指标、并发症、不同时间点(术前、术毕和术后24 h)中心静脉压(CVP)、平均动脉压(MAP)、颈内静脉血氧含量(CjvO2)和动脉血氧含量(CaO2)值。结果 所有患者均完成手术,观察组的血浆总输注量为(464.82±21.55) mL,显著少于对照组[(766.09±38.27) mL],差异有统计学意义(P<0.05),两组的手术时间、术中出血量、住院时间、机械通气时间比较,差异均无统计学意义(P>0.05)。观察组术后谵妄、肺部感染、创面感染、输血不良反应等并发症发生率为4.84%,显著低于对照组(25.81%),差异有统计学意义(P<0.05)。观察组在术前、术毕和术后24 h的MAP、CVP、CaO2和CjvO2值比较,差异均无统计学意义(P>0.05);对照组在术前、术毕和术后24 h的MAP、CVP、CaO2和CjvO2值比较,差异均有统计学意义(P<0.05);观察组术毕MAP、CVP值为(92.44±3.03) mmHg、(6.60±0.82) cmH2O,均高于对照组[(81.76±2.47) mmHg、(4.20±0.14) cmH2O],术毕、术后24 h的CaO2为(176.02±11.47)、(173.09±11.25) mL/L,CjvO2为(114.09±14.25)、(114.22±13.73) mL/L,均高于对照组[(158.76±9.22)、(152.92±10.09) mL/L和(104.76±13.82)、(96.87±11.04) mL/L],差异均有统计学意义(P<0.05)。结论 相对于异体血输注,洗涤式自体血回输在不停跳冠脉搭桥术的应用能改善患者的血流动力学、血氧代谢状况,能减少血浆总输注量,减少患者并发症的发生。Objective To compare the application of different autologous blood transfusion methods in patients after beating coronary artery bypass grafting and their effects on blood oxygen metabolism. Methods From February 2017 to April 2020, 124 cases of patients undergoing beating coronary artery bypass surgery under general anesthesia in Anesthesia Center of First Affiliated Hospital of Xinjiang Medical University were selected as the research objects. All the cases were divided into the observation group and control group with 62 cases in each groups according to the principle of random envelope drawing. The control group were given allogeneic blood transfusion, and the observation group were given werehing autologous blood transfusion. Surgical indicators, complications, central venous pressure(CVP) and mean arterial pressure(MAP) values, and internal jugular venous oxygen content(CjvO2) and arterial oxygen content(CaO2) values at different time points(preoperative, postoperative and 24 h)were recorded in both groups. Results All patients were completed the operation. The total plasma infusion of the observation group was(464.82±21.55) mL, which was significantly less than that in the control group [(766.09±38.27) mL], the difference was statistically significant(P<0.05);there were no significant difference in the operation time, intraoperative blood loss, hospitalization time, and mechanical ventilation time compared between the two groups(P>0.05). The incidence of postoperative complications such as delirium, lung infection, wound infection, and adverse blood transfusion reactions in the observation group were 4.84%, which were significantly lower than in the control group(25.81%), the difference was statistically significant(P<0.05). There was no statistically significant difference in MAP, CVP, CaO2and CjvO2values before, after and 24 hours after operation in the observation group(P>0.05), while there were statistically significant differences in MAP, CVP, CaO2and CjvO2values in the control group before, after a

关 键 词：洗涤式自体血回输 不停跳冠脉搭桥术 血流动力学 血氧代谢 并发症 

分 类 号：R654.2[医药卫生—外科学]