无异体输血的不停跳冠状动脉搭桥术临床应用

发布时间：2018-05-12 09:23

本文选题：冠状动脉旁路移植术 + 冠心病　；参考：《安徽医科大学》2017年硕士论文

【摘要】：目的目前多种血液保护措施已应用于临床,回收式自体输血在非体外循环下冠状动脉旁路移植术中有较高的使用价值。单纯回输洗涤式自体血可能会引起患者凝血功能障碍及影响内环境稳定,造成术后渗血增多,本研究探讨围手术期单纯回输洗涤式自体血在不停跳冠状动脉搭桥术中应用的临床效果。方法回顾性分析2015年8月至2016年7月就诊于我科单一手术医指连续132例行不停跳冠状动脉搭桥术的患者,根据患者围手术期是否输入异体血分为实验组(无异体输血组)和对照组(异体输血组)。对比分析两组患者围手术期输异体血量、自体血回输量、吻合桥血管数量、术后24小时心包纵隔引流量、围手术期呼吸机辅助通气时间、主动脉球囊反搏(IABP)使用情况、术后住院天数及住院费用。对比两组患者术前及术后24小时血红蛋白(HGB)、血小板(PLT)、总胆红素(TBIL)、谷丙转氨酶(ALT)、肌酐(CRE)、凝血酶原时间(PT)变化情况。观察患者输血2h内有无体温升高、皮肤瘙痒或荨麻疹等输血反应现象张生。结果实验组与对照组患者年龄、体重、性别构成、陈旧性心肌梗死病史、左室射血分数及Gesini评分等指标组间均衡性无显著性差异(P0.05),组间有可比性。围手术期呼吸机辅助通气时间实验组19.44±4.60h,对照组23.74±8.42h,P0.001,实验组患者围手术期呼吸机辅助通气时间较对照组短。住院费用实验组11.12±0.17万元,对照组12.22±0.27万元,P0.05,实验组患者围手术期住院费用较对照组低。对照组患者有3例输血后出现输血反应,实验组患者未见明显输血反应(P0.05)。余指标组间差异无统计学意义(P0.05)。结论单纯回输洗涤式自体血在不停跳冠状动脉搭桥术中的应用可纠正围手术期贫血,减少异体输血量,对节省异体血源应用有重要意义,对患者的凝血功能和术后恢复无明显不良影响,且能够降低住院费用,避免输血相关的并张症,可应用于临床。
[Abstract]:Objective at present, many kinds of blood protection measures have been applied in clinic, and the recovery autotransfusion has high value in off-pump coronary artery bypass grafting. The simple transfusion of washed autologous blood may cause coagulation dysfunction and influence the stability of the internal environment, resulting in the increase of blood leakage after operation. The purpose of this study was to investigate the clinical effect of pure washing autologous blood transfusion during perioperative period in coronary artery bypass grafting. Methods from August 2015 to July 2016, 132 consecutive patients underwent coronary artery bypass grafting were analyzed retrospectively. The patients were divided into experimental group (no allotransfusion group) and control group (allogeneic transfusion group) according to whether the patient received allogeneic blood during perioperative period. The volume of allogeneic blood transfusion, the volume of autologous blood transfusion, the number of anastomosed blood vessels, the pericardium and mediastinal drainage at 24 hours after operation, the time of ventilator assisted ventilation in perioperative period, and the use of IABPin in aortic balloon counterpulsation were compared and analyzed between the two groups. Postoperative hospitalization days and hospital expenses. The changes of HGB, PLT, TBILL, alt, creatinine (creatinine) and prothrombin time (PTT) were compared between the two groups before and 24 hours after operation. The blood transfusion reaction such as skin pruritus or urticaria were observed. Results there was no significant difference in age, body weight, sex composition, history of old myocardial infarction, left ventricular ejection fraction and Gesini score between the two groups (P 0.05). The time of ventilator assisted ventilation was 19.44 卤4.60 h in the experimental group and 23.74 卤8.42 h in the control group (P 0.001). The time of ventilator assisted ventilation in the experimental group was shorter than that in the control group. The cost of hospitalization was 11.12 卤1700 yuan in the experimental group and 12.22 卤2700 yuan in the control group (P 0.05). The cost of hospitalization in the experimental group was lower than that in the control group. In the control group, 3 cases had blood transfusion reaction after blood transfusion, but no significant blood transfusion reaction was found in the experimental group (P 0.05). There was no significant difference in other indexes between groups (P 0.05). Conclusion the application of pure washing autologous blood transfusion in beating coronary artery bypass grafting can correct the perioperative anemia, reduce the amount of allogeneic blood transfusion, and have important significance in saving allogeneic blood supply. It has no obvious adverse effect on coagulation function and postoperative recovery of patients, and can reduce hospitalization cost and avoid blood transfusion related syndesmosis. It can be used in clinical practice.
【学位授予单位】：安徽医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R654.2

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