Search

Progress of clinical application of autologous plateletpheresis technology in cardiovascular surgery

The incidence of cardiovascular disease remains high, and surgery is an important measure for the treatment of cardiovascular disease. However, cardiovascular surgery is complicated and difficult, and it is one of the departments with the highest rate of allogeneic blood transfusion. Allogeneic blood transfusion significantly increases the complications and mortality of patients, while autologous blood transfusion can effectively reduce allogeneic blood transfusion and adverse reactions. Autologous plateletpheresis technology is a popular autotransfusion method in recent years. This article reviews the autologous plateletpheresis technology and its clinical application in cardiovascular surgery.

抗c和抗E抗体引起配血不合一例

目的　检测对临床输血有意义的不规则抗体，保证输血安全。 方法　检测对临床输血有意义的不规则抗体，保证输血安全。 结果　患者血型为O型，CCDee，血清含抗c、抗E抗体，选择不含c、E抗原的献血者悬浮红细胞交叉配血并输注，无任何不良反应发生。 结论　在输血前血型血清学试验中，抗体筛选对检测抗c、抗E等临床有意义的不规则抗体，对有效避免溶血性输血反应的发生有重要意义。

Application of Autobloodtransfusion Technique During Operation on Massive Haemorrhage

目的:探讨自体血液回收技术对循环、血细胞和凝血功能的影响及应用效果。方法: 选择急诊大失血手术患者27例,采用ZITI-2000型血液回收机回收血液,经过滤、离心、清洗后回输给患者。分不同时点观察HR、SBP、MAP、DBP、SPO2的变化,并监测RBC、Plt、HB、Hct、FIB、PT、APTT的变化。计算输血量和异体输血率。随机选择8例进行回收原血和回输 血血细胞学比较。结果:(1)术前血压较低,心率较快,回输血液后,HR显著降低(Plt;0.01),SBP和MAP显著升高(Plt;0.01)。(2)术前RBC、HB和Hct均低于正常水平,回输后各时点均升高明显(Plt;0.01)。术前FIB和Plt低于正常水平,回输后各时点增高,但无显著意义。PT、APTT无明显变化。(3)回收原血平均每例3735mL,回输血平均每例1589mL,异体输血率为25％。(4)回输血RBC、HB和Hct均显著高于回收原血(Plt;0.01)。结论:自体血液回收技术用于临床安全可靠,能有效维持循环的稳定,对凝血功能无明显影响,节约血源,减少异体输血。

Correlation Between Perioperative Blood Transfusion and Hepatic Postoperative Infection

ObjectiveTo investigate the correlation between perioperative blood transfusion and hepatic postoperative infection. MethodsOne hundred and thirty patients undergoing hepatic operation were analyzed retrospectively on the relation of perioperative blood transfusion with postoperative infective morbidity and mortality in the period 1989-1999. The patients were divided into blood transfused group and nontransfused group. The major or minor hepatectomy was performed in 53 patients with hepatic malignancy and benign diseases. ResultsIn the blood transfused group, the infective morbidity and perioperative mortality rate was 38.5% and 16.7% respectively, significantly higher than those in nontransfused group (11.5% and 3.8% respectively), P＜0.05. The total lymphocyte count was lower in transfused group than that in nontransfused group. The postoperative antibiotics used time and length of hospital stay were (9.7±4.2) days and (18.7±13.1) days respectively in transfused group than those in nontransfused group (5.3±2.3) days and (12.7±5.2) days respectively. ConclusionThe results suggest that hepatic postoperative infective morbidity and mortality are related with perioperative blood transfusion. Any strategy to reduce blood loss in liver surgery and decrease blood transfusion would be helpful to lower postoperative infective morbidity.

弹簧秤在儿童术中输血计量中的应用

目的 探讨弹簧秤在儿童术中输血计量中的应用效果。 方法 2016 年 8 月 1 日—9 月 15 日对 77 例需要进行术中静脉输血的患儿施行以下措施：将弹簧秤悬挂于输血袋上，通过弹簧秤称重计算患儿输血量及速度。输血前后进行血红蛋白检测，输血后患儿血红蛋白到达正常范围（儿童血红蛋白正常值为 110～160 g/L）为输血有效。 结果 77 例患儿输血后均未发生心肺功能异常、急性肺水肿及输血相关不良反应，输血有效率达到 97.4%。77 例患儿输血前后血红蛋白水平分别为（70.03±3.09）、（113.46±7.58）g/L，差异有统计学意义（t=3.58，P<0.01）。 结论 使用弹簧秤能较为准确地记录患儿术中输血量及输血速度，达到预期输血效果，保证输血安全，且简单易实施。

输血相关可逆性后部脑病综合征伴迟发性脑血管痉挛一例

输血并发症研究的新进展

输血是一种重要的临床治疗手段。但合理的输血一直是个难点，大量输血有可能导致一系列的输血不良反应，如何有效地进行输血管理并降低输血的风险一直是国内外学者重点探讨的课题。在大量参考国内外输血管理和并发症相关文献基础上，现对近年来输血并发症新的认识作一综述。

加强环节管理是提高临床合理用血的重要手段

目的　分析临床用血现状，探讨临床合理用血管理办法。 方法　通过健全组织机构、明确职责、制定切实可行的考核办法对临床用血进行强化管理。明确输血科在临床合理用血管理中的职能作用，发挥其在供血环节上的监督管理作用，提高临床合理用血。 结果　2010年手术台次同比增长4.40%，而临床用血同比下17.4%，血浆用量大幅下降，自身输血增长32.21%，合理用血水平不断提高。 结论　切实加强环节管理能有效提升临床合理用血水平。

Risk factors for perioperative blood transfusion in patients undergoing coronary artery bypass grafting: A systematic review and meta-analysis

ObjectiveTo systematically evaluate the risk factors for perioperative blood transfusion in patients undergoing coronary artery bypass grafting (CABG).MethodsPubMed, Web of Science, The Cochrane Library, EMbase, CNKI, WanFang and VIP Database were electronically searched to collect case-control and cohort studies about the risk factors for perioperative blood transfusion in patients undergoing CABG from inception to February 2020. Two reviewers screened and evaluated the literatures according to the inclusion and exclusion criteria, and meta-analysis was performed by using RevMan 5.3 software.ResultsA total of 26 articles were collected, involving 84 661 patients. The results of meta-analysis showed that age (OR=1.06, 95%CI 1.03 to 1.08, P<0.001), age≥70 years (OR=2.14, 95%CI 1.77 to 2.59, P<0.001), female (OR=1.85, 95%CI 1.55 to 2.22, P<0.001), body mass index (OR=0.94, 95%CI 0.90 to 0.98, P=0.003), weight (OR=0.95, 95%CI 0.93 to 0.96, P<0.001), body surface area (OR=0.19, 95%CI 0.10 to 0.39, P<0.001), smoking (OR=0.80, 95%CI 0.69 to 0.93, P=0.003), diabetes (OR=1.15, 95%CI 1.09 to 1.20, P<0.000 01), chronic heart failure (OR=1.59, 95%CI 1.26 to 1.99, P<0.001), number of diseased coronary arteries (OR=1.17, 95%CI 1.01 to 1.35, P=0.030), reoperation (OR=2.12, 95%CI 1.79 to 2.51, P<0.001), preoperative hemoglobin level (OR=0.60, 95%CI 0.43 to 0.84, P=0.003), preoperative ejection fraction <35% (OR=2.57, 95%CI 1.24 to 5.34, P=0.010), emergency surgery (OR=4.09, 95%CI 2.52 to 6.63, P<0.001), urgent operation (OR=2.28, 95%CI 1.25 to 4.17, P=0.007), intra-aortic balloon pump (OR=3.86, 95%CI 3.35 to 4.44, P<0.001), cardiopulmonary bypass (OR=4.24, 95%CI 2.95 to 6.10, P<0.001), cardiopulmonary bypass time (OR=1.01, 95%CI 1.01 to 1.01, P<0.000 01) and minimum hemoglobin during cardiopulmonary bypass (OR=0.42, 95%CI 0.23 to 0.77, P=0.005) were the risk factors for perioperative blood transfusion in patients undergoing CABG.ConclusionCurrent evidence shows that age, age≥70 years, female, body mass index, weight, body surface area, smoking, diabetes, chronic heart failure, number of diseased coronary arteries, reoperation, preoperative hemoglobin level, preoperative ejection fraction<35%, emergency surgery, urgent operation, intra-aortic balloon pump, cardiopulmonary bypass, cardiopulmonary bypass time and minimum hemoglobin during cardiopulmonary bypass are risk factors for perioperative blood transfusion in patients who undergo CABG. Medical staff should formulate and improve the relevant perioperative blood management measures according to the above risk factors, in order to reduce the perioperative blood utilization rate and improve the clinical prognosis of patients.

输血申请不合格原因分析与对策

目的　通过分析医院输血申请不合格的原因，探讨改进对策。 方法　对2009年1月－2010年12月发生的698例不合格输血申请原因逐一进行分析，并提出具体改进措施。 结果　不合格的输血申请各个科室均有，主要集中于输血量较大的血液科、胸外ICU、SICU等科室，不合格的原因包括申请单不合格（主治医师未审核盖章、护士未签名、申请单污染或打印不清晰）与合血标本不合格（血量不够、样本泄漏、标本联号与申请单不一致或不清晰、未重新抽合血标本、抽错患者），其中合血标本不合格占92%。 结论　加强对医务人员的责任感教育，强化操作培训以及细化临床使用手册，可减少输血申请环节的差错，以降低医疗风险。