一种体外循环术后余血回收超滤装置的临床使用观察  

Clinical observation of ultrafiltration device for recovering residual blood after cardiopulmonary bypass

作　　者：赵成秀[1] 稂与恒[2] 段大为[2] 张光信[1] 王岩英[1] 赵民[1] 李珍珍 康敏 ZHAO Cheng-xiu;LANG Yu-heng;DUAN Da-wei;ZHANG Guang-xin;WANG Yan-ying;ZHAO Min;LI Zhen-zhen;KANG Min(Department of Anesthesiology,Handan First Hospital,Handan 056002,Hebei,China;HeartCenter Third Central Hospital,Tianjin 300170,China)

机构地区：[1]邯郸市第一医院麻醉科,河北邯郸056002 [2]天津市第三中心医院心脏中心,天津300170

出　　处：《生物医学工程与临床》2023年第1期76-81,共6页Biomedical Engineering and Clinical Medicine

基　　金：河北省卫生计划生育委员会医学科学研究重点课题(20171087);河北省科技厅重点研发计划项目(20377752D)。

摘　　要：目的观察一种离线血袋超滤装置处理体外循环(CPB)余血回输方式对患者的回收作用,为心脏术后选择合理的余血回输模式提供参考依据并观察其临床疗效。方法用输血袋、超滤器、6 mm连接管路、6×6两通接头、废液袋组成血袋超滤装置,将体外循环结束后的余血全部打入血袋超滤装置,经循环超滤后回输给患者。选择2019年3月至2020年3月于邯郸市第一医院心外科在CPB下行心脏手术患者75例,其中男性46例,女性29例;年龄20~70岁,平均年龄52.73岁(标准差12.39岁);身高155~178 cm,平均身高168.40 cm(标准差7.39 cm)。观察择期体外循环心脏手术患者机血不同处理前后变化及回收效果,分为血袋超滤组、离心/洗涤组及环路超滤组,每组各25例。比较各组机器余血处理后血红蛋白(Hb)、红细胞压积(HCT)、血小板计数(Plt)、总蛋白、白蛋白、纤维蛋白原(FIB)计数变化;观察回输机血量、机械通气时间、24 h胸引量、重症监护病房(ICU)停留时间、输余血2 h后Hb和HCT、接受异体血量。结果血袋超滤回收余血后Hb、HCT、Plt计数、总蛋白、白蛋白、FIB均有所提高,与处理前比较差异有统计学意义(P<0.05);机体回输经血袋超滤处理的机血后Hb、HCT较停机时有所提高,与停机时比较差异有统计学意义(P<0.05),术后没有相关并发症。血袋超滤组处理后Hb、HCT、Plt、总蛋白、白蛋白、FIB高于环路超滤组,差异有统计学意义(P<0.05)。血袋超滤组处理后Plt、总蛋白、白蛋白、FIB高于离心/洗涤组,差异均有统计学意义(P<0.05);Hb、HCT两组比较,差异无统计学意义(P>0.05)。3组术后机血回收量及其他临床结果比较,差异无统计学意义(P>0.05);离心/洗涤组接受血浆量高于其他两组,差异有统计学意义(P<0.05)。术后无相关并发症。结论停机后血袋超滤可以顺利完成对体外循环余血的浓缩并回输患者,患者可获得较高、更稳定浓�Objective To observe the recovery effect of an off-line blood bag ultrafiltration device in patients with cardiopulmonary bypass residual blood transfusion,and provide reference for selecting reasonable residual blood transfusion mode after cardiac surgery and observe its clinical efficacy.Methods The blood bag ultrafiltration device was composed of blood bag,ultrafiltration device,6 mm connecting pipeline,6×6 binary channel connector and waste liquid bag.After cardiopulmonary bypass,residual blood was all pumped into blood bag ultrafiltration device,then transfused back to patient after circulation ultrafiltration.From March 2019 to March 2020,a total of 75 patients performed cardiac surgery under CPB were enrolled,which included 46 males and 29 females,aged 20-70 years old with mean age of 52.73 years old(standard deviation 12.39 years old);height was 155-178 cm with mean height of 168.40 cm(standard deviation 7.39 cm).The changes and recovery effects of residual blood before and after different treatments were observed in patients performed elective cardiopulmonary bypass cardiac surgery,all of them were divided into blood bag ultrafiltration group,centrifugation/washing group and loop ultrafiltration group,with 25 cases in each group.The changes of hemoglobin(Hb),hematocrit(HCT),platelet count(Plt),total protein,albumin and fibrinogen(FIB)were compared in 3 groups,the blood volume of reinfusion machine,mechanical ventilation time,chest drainage volume in 24-hour,intensive care unit treatment time,Hb,HCT expression 2-hour post transfusion of remaining blood,and amount allogeneic blood were observed.Results The levels of Hb,HCT,Plt count,total protein,albumin and FIB were statistically significantly increased after ultrafiltration than before(P<0.05).The Hb and HCT of the body after reinfusion of ultrafiltration treated blood bags were statistically significantly higher than those after stoppage(P<0.05),and there were no related complications after operation.After treatment,Hb,HCT,Plt,total protein,albumin and

关 键 词：心脏手术 体外循环 超滤 改良超滤装置 余血回收 

分 类 号：R654.1[医药卫生—外科学] R619[医药卫生—临床医学]