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(1)
摘要：目的 观察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(OPCABG)中应用的临床效果。方法 回顾性分析2015年8月～2016年7月于我科择期拟行OPCABG的132例患者，根据是否输入异体血分为实验组和对照组，比较两组患者术前及术后24 h血红蛋白(HGB)、血小板(PLT)、总胆红素(TBIL)、谷丙转氨酶(ALT)、肌酐(CRE)、凝血酶原時间(PT)变化情况，记录围手术期输血量、呼吸机辅助通气时间、术后住院天数及住院费用等相关指标。结果 实验组较对照组患者围手术期呼吸机辅助通气时间短、住院费用低(P<0.05)，其余指标组间差异无统计学意义(P>0.05)。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节约血源，降低住院费用，对患者术后恢复无明显不良影响。
关键词：冠状动脉搭桥术；血液保护；自体输血
Application of Simple Transfusion of Autologous Blood in Coronary Artery Bypass Grafting
, http://www.100md.com
WANG Hai-yang1，GE Jian-jun2
(1.Anhui Medical University，Hefei 230022，Anhui，China；
2.Department of Cardiology，the First Affiliated Hospital of Anhui Medical University，Hefei 230022，Anhui，China)
Abstract：Objective To observe the clinical effect of perioperative simple transfusion of autologous blood in open coronary artery bypass grafting (OPCABG).Methods A total of 132 patients with OPCABG were enrolled in this study from August 2015 to July 2016.According to whether the input of allogeneic blood was divided into experimental group and control group，operation of the two groups were compared before and after 24 h of hemoglobin(HGB)，platelet(PLT)，total bilirubin(TBIL)，alanine aminotransferase(ALT)，creatinine(CRE)，prothrombin time(PT)changes，records of perioperative blood transfusion， mechanical ventilation time，postoperative hospital stay and the hospitalization expenses and other related indicators. Results In the experimental group than in the control of perioperative ventilation in short time group，low cost of hospitalization(P<0.05)，the other showed no statistically significant difference between groups(P>0.05).Conclusion Simple transfusion of washed autologous blood in off-pump coronary artery bypass grafting in the application can save blood.To reduce the cost of hospitalization，no significant adverse effects on the postoperative recovery of patients.
, http://www.100md.com
Key words：Coronary artery bypass surgery；Blood protection；Autologous blood transfusion
冠状动脉旁路移植术(coronary artery bypass grafting，CABG)是左主干病变或多支冠状动脉病变的主要治疗手段，其能有效消除或改善心绞痛症状、增加心肌血供、延长患者生命、减少不良心血管事件的发生。不停跳冠状动脉搭桥术(off - pump coronary artery bypass grafting，OPCABG)较体外循环辅助下冠状动脉搭桥术可缩短手术时间，尤其针对心功能较差、肾功能不全的患者有明显好处，目前OPCABG已得到广泛的认可和应用[1]。随着心脏外科等复杂大手术的常规开展，临床用血量日趋增加，异体血源紧张，目前多种血液保护措施尤其是术中回收式自体输血已在出血量较多的手术中广泛应用。血细胞回输仪所收集的洗涤血中大部分血小板、凝血因子丢失，几乎仅保留了红细胞，大量回输可能会引起患者凝血功能障碍及影响内环境稳定[2]，本研究的主要目的即观察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性能评价。
1 资料与方法
1.1一般资料 回顾性分析2015年8月～2016年7月就诊于安徽医科大学第一附属医院心脏外科单一手术医师连续132例行OPCABG的患者，男81例，女51例。所有患者均经冠状动脉造影检查，明确有冠心病且需外科手术干预。入选条件：年龄<80岁，体重>50 kg，无贫血，术前血常规、肝肾功能、凝血功能无明显异常。排除标准：合并心脏瓣膜病变或心室壁瘤形成，左室射血分数(LVEF)<45%，合并呼吸衰竭(吸氧前动脉血气分析氧分压小于60 mmHg)，术前使用主动脉内球囊反搏或需在体外循环辅助下行CABG。根据患者围手术期是否输入异体血分为实验组(单纯回输洗涤式自体血组)和对照组(额外输入异体血组)。, http://www.100md.com(王海洋 葛建军)
关键词：冠状动脉搭桥术；血液保护；自体输血
Application of Simple Transfusion of Autologous Blood in Coronary Artery Bypass Grafting
, http://www.100md.com
WANG Hai-yang1，GE Jian-jun2
(1.Anhui Medical University，Hefei 230022，Anhui，China；
2.Department of Cardiology，the First Affiliated Hospital of Anhui Medical University，Hefei 230022，Anhui，China)
Abstract：Objective To observe the clinical effect of perioperative simple transfusion of autologous blood in open coronary artery bypass grafting (OPCABG).Methods A total of 132 patients with OPCABG were enrolled in this study from August 2015 to July 2016.According to whether the input of allogeneic blood was divided into experimental group and control group，operation of the two groups were compared before and after 24 h of hemoglobin(HGB)，platelet(PLT)，total bilirubin(TBIL)，alanine aminotransferase(ALT)，creatinine(CRE)，prothrombin time(PT)changes，records of perioperative blood transfusion， mechanical ventilation time，postoperative hospital stay and the hospitalization expenses and other related indicators. Results In the experimental group than in the control of perioperative ventilation in short time group，low cost of hospitalization(P<0.05)，the other showed no statistically significant difference between groups(P>0.05).Conclusion Simple transfusion of washed autologous blood in off-pump coronary artery bypass grafting in the application can save blood.To reduce the cost of hospitalization，no significant adverse effects on the postoperative recovery of patients.
, http://www.100md.com
Key words：Coronary artery bypass surgery；Blood protection；Autologous blood transfusion
冠状动脉旁路移植术(coronary artery bypass grafting，CABG)是左主干病变或多支冠状动脉病变的主要治疗手段，其能有效消除或改善心绞痛症状、增加心肌血供、延长患者生命、减少不良心血管事件的发生。不停跳冠状动脉搭桥术(off - pump coronary artery bypass grafting，OPCABG)较体外循环辅助下冠状动脉搭桥术可缩短手术时间，尤其针对心功能较差、肾功能不全的患者有明显好处，目前OPCABG已得到广泛的认可和应用[1]。随着心脏外科等复杂大手术的常规开展，临床用血量日趋增加，异体血源紧张，目前多种血液保护措施尤其是术中回收式自体输血已在出血量较多的手术中广泛应用。血细胞回输仪所收集的洗涤血中大部分血小板、凝血因子丢失，几乎仅保留了红细胞，大量回输可能会引起患者凝血功能障碍及影响内环境稳定[2]，本研究的主要目的即观察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性能评价。
1 资料与方法
1.1一般资料 回顾性分析2015年8月～2016年7月就诊于安徽医科大学第一附属医院心脏外科单一手术医师连续132例行OPCABG的患者，男81例，女51例。所有患者均经冠状动脉造影检查，明确有冠心病且需外科手术干预。入选条件：年龄<80岁，体重>50 kg，无贫血，术前血常规、肝肾功能、凝血功能无明显异常。排除标准：合并心脏瓣膜病变或心室壁瘤形成，左室射血分数(LVEF)<45%，合并呼吸衰竭(吸氧前动脉血气分析氧分压小于60 mmHg)，术前使用主动脉内球囊反搏或需在体外循环辅助下行CABG。根据患者围手术期是否输入异体血分为实验组(单纯回输洗涤式自体血组)和对照组(额外输入异体血组)。, http://www.100md.com(王海洋 葛建军)