不同方法输注机余血对瓣膜置换术患者围术期凝血功能的影响  

Effects of Different Transfusion Methods of Machine Residual Blood on Perioperative Coagulation Function of Patients Undergoing Valve Replacement

作　　者：刘玉妍 刘小丹 谢伟贤 梁秀生[1] 龚建平 Liu Yu-yan;Liu Xiao-dan;Xie Wei-xian;Liang Xiu-sheng;Gong Jian-ping(Department of Anesthesiology,The Sixth Affiliated Hospital of Guangzhou Medical University(Qingyuan People's Hospital),Qingyuan 511518,Guangdong Province,China)

机构地区：[1]广州医科大学附属第六医院(清远市人民医院)麻醉科,广东清远511518

出　　处：《中国社区医师》2023年第2期54-56,共3页Chinese Community Doctors

基　　金：清远市科技计划项目(编号:180614161900442)。

摘　　要：目的:探讨不同方法输注机余血对瓣膜置换术患者围术期凝血功能的影响。方法:选取2018年1月-2021年12月广州医科大学附属第六医院收治的40例瓣膜置换手术患者为研究对象,根据随机数字表法分为试验组与对照组,各20例。试验组在拔出主动脉插管前,全部机余血从主动脉直接回输给患者;对照组在拔出主动脉插管后,全部机余血回收到储血袋,在3 h内从颈内静脉全部回输给患者。比较两组凝血功能指标、血常规、患者鱼精蛋白追加量、关胸止血时间、胸腔引流量。结果:试验组术后即刻活化部分凝血活酶时间(APTT)、凝血酶时间(TT)短于对照组,差异有统计学意义(P<0.05);试验组术后第1天APTT短于对照组,差异有统计学意义(P<0.05)。两组术前红细胞压积、血红蛋白比较,差异无统计学意义(P>0.05);试验组术后胸腔引流量、术中鱼精蛋白追加量少于对照组,关胸止血时间短于对照组,差异有统计学意义(P<0.05)。结论:机余血经主动脉插管从主动脉直接回输的方法较机余血回收到储血袋,再从颈内静脉回输的方法能明显改善术后凝血功能,减少术中鱼精蛋白使用量、缩短关胸止血时间,减少术后胸腔引流量,可有效预防术后因肝素过剩导致的出血渗液。Objective:To investigate the effects of different transfusion methods of machine residual blood on perioperative coagulation function of patients undergoing valve replacement.Methods:A total of 40 patients undergoing valve replacement surgery in the Sixth Affiliated Hospital of Guangzhou Medical University from January 2018 to December 2021 were selected as the study subjects.According to random number table method,the patients were divided into experimental group and control group,with 20 cases in each group.In experimental group,before pulling out the aortic cannula,all the residual blood was directly reinfused via the aorta to the patients;In control group,after pulling out the aortic cannula,all the residual blood was recovered to the blood storage bag and reinfused to the patient via the internal jugular vein within 3 h.Blood coagulation function indexes,blood routine test,additional amount of protamine in patients,time of hemostasis in thoracic closure,and thoracic drainage amount in the two groups were compared.Results:The activated partial thromboplastin time (APTT) and prothrombin time (TT) in the experimental group were shorter than those in the control group immediately after surgery,and the difference was statistically significant (P<0.05).The APTT in the experimental group was shorter than that in the control group on postoperative day 1,and the difference was statistically significant (P<0.05).There was no significant difference in perioperative hematocrit and hemoglobin between the two groups (P>0.05).The postoperative thoracic drainage amount and intraoperative protamine addition amount in the experimental group were less than those in the control group,and the time of hemostasis in thoracic closure was shorter than that in the control group,and the difference was statistically significant (P<0.05).Conclusion:Compared with the method of recovering machine residual blood in blood storage bag and then reinfusing to the patient via the internal jugular vein,the method of direct reinfusion of machine

关 键 词：瓣膜置换手术 凝血功能 机余血 鱼精蛋白 

分 类 号：R654.2[医药卫生—外科学]