预存式自体血回输技术在择期体外循环心脏手术中的临床应用

刘言一; 朱海娟; 董文鹏; 朱帮强; 李祥云; 李峰

doi:10.16766/j.cnki.issn.1674-4152.002805

预存式自体血回输技术在择期体外循环心脏手术中的临床应用

doi: 10.16766/j.cnki.issn.1674-4152.002805

1.
安徽医科大学第一附属医院心脏外科, 安徽合肥 230022
2.
安徽医科大学附属妇幼保健院麻醉科, 安徽合肥 230001
3.
安徽医科大学第一附属医院输血科
4.
安徽医科大学第一附属医院检验科

基金项目:

国家自然科学基金青年科学基金项目 82100315

安徽医科大学第一附属医院临床研究启动计划项目 LCYJ2021YB016

详细信息

通讯作者:
李峰, E-mail：mdlif@163.com

中图分类号: R654.2
计量
- 文章访问数: 353
- HTML全文浏览量: 103
- PDF下载量: 7
- 被引次数: 0
出版历程
- 收稿日期: 2022-08-02
- 网络出版日期: 2023-04-07

Clinical application of preoperative autologous blood donation in selective cardiac surgery under extracorporeal circulation

1.
Department of Cardiac Surgery, the First Affiliated Hospital of Anhui Medical University, Hefei, Anhui 230022, China

摘要

摘要: 目的研究预存式自体血回输技术(PABD)在择期体外循环(cardiopulmonary bypass, CPB)心脏手术中的临床应用效果，探讨PABD的安全性及可行性。方法纳入2015年1月—2021年7月安徽医科大学第一附属医院心脏外科使用预存式自体血回输技术行择期体外循环心脏手术的81例患者为观察组，按性别相同、基础血红蛋白(hemoglobin, Hb)±1.5g/dL、术式相同或相近且由同一治疗组完成的原则，从同期使用异体输血行择期体外循环心脏手术的患者中按1 :1的比例进行匹配作为对照组。比较2组患者在血制品输注量、输血相关费用、术后恢复指标、术后相关并发症发生率等方面的差异。结果与对照组比较，观察组总库存红细胞(red blood cell, RBC)输注量[2.00(0.00, 4.00)U vs. 5.50(4.00, 8.00)U]、总血浆输注量[600.00(400.00, 800.00)mL vs. 800.00(600.00, 1 325.00)mL]、术后24 h引流量[445.00(310.00, 567.50)mL vs. 575.00(433.50, 860.00)mL]、机械通气时间[16.00(8.00, 18.00)h vs. 18.00(11.00, 26.00)h]、监护室(intensive care unit, ICU)停留时间[43.00(36.00, 65.00)h vs. 58.00(41.00, 94.00)h]均显著降低(均P＜0.05)。观察组术后急性肾衰竭、血红蛋白尿、机械通气时间延长等并发症发生率均显著低于对照组(均P＜0.05)。2组患者输血相关费用比较差异有统计学意义(P＜0.05)。结论预存式自体血回输技术可显著减少患者异体红细胞及血浆输注量，且有利于降低术后并发症发生率，促进患者术后恢复。
- 预存式自体输血 /
- 心脏外科 /
- 体外循环 /
- 择期手术
Abstract: Objective This study aimed to investigate the clinical values of preoperative autologous blood donation (PABD) in selective cardiac surgeries under extracorporeal circulation (SCSUEC) and to discuss the safety and feasibility of PABD. Methods A total of 81 patients who consecutively received SCSUEC combined with PABD in the First Affiliated Hospital of Anhui Medical University from January 2015 to July 2021 were enrolled as the experimental group. Another 81 patients from the same hospital were matched by gender and baseline haemoglobin level (±1.5 g/dL), and they received SCSUEC at a ratio of 1 :1, which were determined as the case control. Comprehensive comparisons in the transfusion amount of allogenic RBC and plasma, the cost of transfusion, the postoperative recovery parameters and postoperative complications were conducted between the two groups. Results Compared with the case control, participants in the experimental group have significantly less allogenic RBC transfusion [2.00 (0.00, 4.00) U vs. 5.50 (4.00, 8.00) U], less allogenic plasma transfusion [600.00 (400.00, 800.00) mL vs. 800.00 (600.00, 1 325.00) mL], less first 24 h drainage [445.00 (310.00, 567.50) mL vs. 575.00 (433.50, 860.00) mL], shorter mechanical ventilation time [16.00 (8.00, 18.00) h vs. 18.00 (11.00, 26.00) h] and shorter ICU stay [43.00 (36.00, 65.00) h vs. 58.00 (41.00, 94.00) h] were significantly decreased (all P < 0.05). Furthermore, less incidence of acute renal failure, haemoglobinuria and prolonged mechanical ventilation were observed in the experimental group (all P < 0.05). The difference in costs related to blood transfusion was statistically significant between two groups (P < 0.05). Conclusion PABD can reduce the demand for allogenic RBC and plasma transfusion in SCSUEC. It can also be used to avoid postoperative complications and promote postoperative recovery.
- Preoperative autologous blood donation /
- Cardiac surgery /
- Extracorporeal circulation /
- Selective surgery

HTML全文

表 1 2组择期体外循环心脏手术患者基线资料比较

Table 1. Comparison of baseline data between two groups of patients undergoing elective cardiopulmonary bypass cardiac surgery

组别	例数	年龄(x±s, 岁)	体重(x±s, kg)	体外循环时间(x±s, min)	基础Hb (x±s, g/L)	基础PLT (x±s, ×10⁹/L)	基础凝血酶原时间(x±s, s)	术前肌酐(x±s, μmol/L)
观察组	81	49.07±14.41	64.44±11.80	146.33±53.31	143.52±11.56	200.75±62.78	13.15±1.30	78.94±21.43
对照组	81	52.54±12.62	62.78±12.48	143.84±43.39	142.57±11.05	190.95±57.61	13.38±1.83	77.60±21.61
统计量		1.810^a	0.912^a	0.376^a	1.326^a	0.997^a	0.927^a	0.440^a
P值		0.074	0.365	0.708	0.189	0.322	0.357	0.661

组别	例数	高血压[例(%)]	糖尿病[例(%)]	脑血管病[例(%)]	NYHA Ⅰ/Ⅱ级[例(%)]	左心室射血分数(x±s, %)	左心室舒张期末径(x±s, mm)	左心房内径(x±s, mm)
观察组	81	18(22.2)	1(1.2)	2(2.5)	30(37.0)	59.99±7.45	53.09±9.29	47.43±10.91
对照组	81	18(22.2)	4(4.9)	3(3.7)	32(39.5)	58.06±8.33	54.84±8.84	47.21±8.84
统计量		0.033^b	0.800^b	0.000^b	0.028^b	1.632^a	1.690^a	0.167^a
P值		0.999	0.375	0.999	0.868	0.107	0.095	0.868
注：^a为t值，^b为χ²值。

下载: 导出CSV

表 2 2组择期体外循环心脏手术患者术中及术后输血情况比较[M(P₂₅, P₇₅)]

Table 2. Comparison of intraoperative and postoperative blood transfusion in two groups of patients undergoing elective cardiopulmonary bypass cardiac surgery[M(P₂₅, P₇₅)]

组别	例数	术中RBC用量(U)	术后RBC用量(U)	总RBC用量(U)	术中血浆用量(mL)	术后血浆用量(mL)	总血浆用量(mL)	输血相关费用(元)
观察组	81	0.00(0.00, 0.25)	2.00(0.00, 4.00)	2.00(0.00, 4.00)	200.00(0.00, 400.00)	400.00(0.00, 600.00)	600.00(400.00, 800.00)	1 003.50(607.75, 1 497.25)
对照组	81	2.00(0.00, 3.25)	4.00(2.75, 6.00)	5.50(4.00, 8.00)	300.00(0.00, 600.00)	600.00(300.00, 1 100.00)	800.00(600.00, 1 325.00)	1 712.50(1 273.25, 2 624.25)
Z值		-4.786	-4.331	-6.054	-1.786	-3.898	-4.422	-4.974
P值		＜0.001	＜0.001	＜0.001	0.074	＜0.001	＜0.001	＜0.001

下载: 导出CSV

表 3 2组择期体外循环心脏手术患者术后恢复指标及围手术期并发症比较

Table 3. Comparison of postoperative recovery indicators and perioperative complications between two groups of patients undergoing elective cardiopulmonary bypass cardiac surgery

组别	例数	机械通气时间[M(P₂₅, P₇₅), h]	术后24 h引流量[M(P₂₅, P₇₅), mL]		ICU停留时间[M(P₂₅, P₇₅), h]	术后住院时间[M(P₂₅, P₇₅), d]	出院前Hb (x±s, g/L)	出院前PLT (x±s, ×10⁹/L)
观察组	81	16.00(8.00, 18.00)	445.00(310.00, 567.50)		43.00(36.00, 65.00)	12.00(10.00, 15.00)	112.51±14.32	251.15±106.47
对照组	81	18.00(11.00, 26.00)	575.00(433.50, 860.00)		58.00(41.00, 94.00)	13.00(10.00, 17.50)	108.72±22.96	248.52±139.00
统计量		-2.335^a	-4.169^a		-2.880^a	-0.894^a	1.281^b	0.036^b
P值		0.020	＜0.001		0.004	0.371	0.204	0.971

组别	例数	在院死亡[例(%)]	低心排[例(%)]	急性肾衰竭[例(%)]	延长机械通气时间>48 h[例(%)]	血红蛋白尿[例(%)]	肝功能不全[例(%)]	切口感染[例(%)]
观察组	81	3(3.7)	2(2.5)	3(3.7)	5(6.2)	1(1.2)	1(1.2)	3(3.7)
对照组	81	3(3.7)	6(7.4)	12(14.8)	14(17.3)	10(12.3)	7(8.6)	5(6.2)
统计量		0.167^c	1.125^c	4.267^c	4.267^c	5.818^c	3.125^c	0.125^c
P值		0.999	0.289	0.035	0.035	0.012	0.070	0.727
注：^a为Z值，^b为t值，^c为χ²值。

下载: 导出CSV

参考文献(15)

[1]	谢屹红, 戴备军, 沈社良. 血栓弹力图指导体外循环心脏手术围术期输血对患者出血量、输血量和临床结局的影响[J]. 中华全科医学, 2019, 17(5): 756-760. doi: 10.16766/j.cnki.issn.1674-4152.000784 XIE Y H, DAI B J, SHEN S L. Comparison of thromboelastography and standard coagulation tests guided perioperative period transfusion in patients undergoing cardiac surgery with cardiopulmonary bypass[J]. Chinese Journal of General Practice, 2019, 17(5): 756-760. doi: 10.16766/j.cnki.issn.1674-4152.000784
[2]	黄慧瑛, 黄建云, 魏亚明, 等. 贮存式自体血输注在普外科择期手术中的临床应用研究[J]. 中国实验血液学杂志, 2020, 28(3): 967-971. https://www.cnki.com.cn/Article/CJFDTOTAL-XYSY202003046.htm HUANG H Y, HUANG J Y, WEI Y M, et al. Clinical application of preoperative autologous blood donation in selective general surgery[J]. Journal of Experimental Hematology, 2020, 28(3): 967-971. https://www.cnki.com.cn/Article/CJFDTOTAL-XYSY202003046.htm
[3]	FRANK S M, SIKORSKI R A, KONIG G, et al. Clinical utility of autologous salvaged blood: a review[J]. J Gastrointest Surg, 2020, 24(2): 464-472. doi: 10.1007/s11605-019-04374-y
[4]	李倩, 吕红, 刘岳, 等. 心血管手术围术期抗纤溶治疗的有效性及安全性[J]. 中国临床药理学与治疗学, 2021, 26(7): 830-835. https://www.cnki.com.cn/Article/CJFDTOTAL-YLZL202107016.htm LI Q, LYU H, LIU Y, et al. Efficacy and safety of antifibrinolytic therapy in the perioperative cardio-vascular surgery[J]. Chinese Journal of Clinical Pharmacology and Therapeutics, 2021, 26(7): 830-835. https://www.cnki.com.cn/Article/CJFDTOTAL-YLZL202107016.htm
[5]	郑伟健, 方卫平, 汪欢, 等. 回收式自体输血在老年患者不停跳冠脉搭桥术中的应用[J]. 安徽医科大学学报, 2018, 53(10): 1602-1605. https://www.cnki.com.cn/Article/CJFDTOTAL-YIKE201810024.htm ZHENG W J, FANG W P, WANG H, et al. Application of intraoperative blood salvage in elderly patients with off-pump coronary artery bypass grafting[J]. Acta Universitatis Medicinalis Anhui, 2018, 53(10): 1602-1605. https://www.cnki.com.cn/Article/CJFDTOTAL-YIKE201810024.htm
[6]	丁洁岚, 冯娟, 陈皆锋, 等. 产科大量输血方案的临床研究进展[J]. 中华全科医学, 2022, 20(3): 468-472. doi: 10.16766/j.cnki.issn.1674-4152.002380 DING J L, FENG J, CHEN J F, et al. Clinical research progress related to massive blood transfusion in obstetrics[J]. Chinese Journal of General Practice, 2022, 20(3): 468-472. doi: 10.16766/j.cnki.issn.1674-4152.002380
[7]	VLOT E A, VERWIJMEREN L, VAN DE GARDE E, et al. Intra-operative red blood cell transfusion and mortality after cardiac surgery[J]. BMC Anesthesiol, 2019, 19(1): 65.
[8]	MING Y, LIU J, ZHANG F, et al. Transfusion of red blood cells, fresh frozen plasma, or platelets is associated with mortality and infection after cardiac surgery in a dose-dependent manner[J]. Anesth Analg, 2020, 130(2): 488-497.
[9]	SULTAN I, BIANCO V, BROWN J A, et al. Long-term impact of perioperative red blood cell transfusion on patients undergoing cardiac surgery[J]. Ann Thorac Surg, 2021, 112(2): 546-554.
[10]	YOU G X, LI B T, WANG Z, et al. Effects of different plasma expanders on rats subjected to severe acute normovolemic hemodilution[J]. Mil Med Res, 2020, 7(1): 55.
[11]	ADAM E H, FUNKE M, ZACHAROWSKI K, et al. Impact of intraoperative cell salvage on blood coagulation factor concentrations in patients undergoing cardiac surgery[J]. Anesth Analg, 2020, 130(5): 1389-1395.
[12]	龚由伟, 薛颖泓, 唐涌连, 等. 预存式自体输血对原发性肝癌患者围术期免疫功能的影响[J]. 广西医科大学学报, 2020, 37(9): 1648-1652. https://www.cnki.com.cn/Article/CJFDTOTAL-GXYD202009014.htm GONG Y W, XUE Y H, TANG Y L, et al. Effect of preoperative autologous blood donation on perioperative immune function in patients with primary liver cancer[J]. Journal of Guangxi Medical University, 2020, 37(9): 1648-1652. https://www.cnki.com.cn/Article/CJFDTOTAL-GXYD202009014.htm
[13]	GRETCHEN C, BAYIR H, KOCHANEK P M, et al. Association between hyperoxemia and increased cell-free plasma hemoglobin during cardiopulmonary bypass in infants and children[J]. Pediatr Crit Care Med, 2022, 23(2): e111-e119.
[14]	KINDZELSKI B A, CORCORAN P, SIEGENTHALER M P, et al. Postoperative acute kidney injury following intraoperative blood product transfusions during cardiac surgery[J]. Perfusion, 2018, 33(1): 62-70.
[15]	RASMUSSEN S R, KANDLER K, NIELSEN R V, et al. Association between transfusion of blood products and acute kidney injury following cardiac surgery[J].Acta Anaesthesiol Scand, 2020, 64 (10):1397-1404.