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目的:探讨自体血回输对体外循环下心瓣膜置换术患者凝血及携氧功能的影响。方法:以行自体血回输的56例心脏瓣膜置换患者为研究对象,记录自体血回输量、不良反应及术后恢复情况。检测术前、术毕、术后24h及术后7d凝血及携氧功能指标。采用全自动血液分析仪检测红细胞计数(RBC)、血红蛋白含量(HGB)、血细胞比容(Hct)、血小板(PLT);采用全自动血凝分析仪测定凝血酶原时间(PT)、凝血活酶时间(APTT)、凝血酶时间(TT)、纤维蛋白原(FIB)、D-二聚体(D-D);采用全自动血气分析仪测定酸碱度(pH)、氧分压(PaO_2)、血氧饱和度(SaO_2)。结果:156例患者平均回输浓缩红细胞(489±245)ml。自体血回输过程中均未发生严重不良反应,术后恢复情况良好。2与术前比较,术毕及术后24hPLT、FIB明显下降(P<0.01);而PT明显延长(P<0.05或P<0.01);术毕D-D有所升高(P<0.05)。术毕及术后24h PaO_2明显升高(P<0.01);术毕及术后24h RBC、HGB和Hct均有一定程度下降(P<0.01或P<0.05)。结论:应用自体血液回收机对术中失血进行及时回收、回输,对体外循环下心瓣膜置换术患者凝血功能及携氧能力影响较小,可有效维持血液循环,有一定的临床推广应用价值。
Objective: To investigate the effect of autologous blood transfusion on coagulation and oxygen carrying capacity in patients undergoing cardiac valve replacement under cardiopulmonary bypass. Methods: Fifty-six patients undergoing heart valve replacement with autologous blood transfusion were enrolled. The volume of autologous blood transfusion, adverse reactions and postoperative recovery were recorded. Preoperative, postoperative, 24h and 7d postoperative coagulation and oxygen carrying function indicators. The RBC, HGB, Hct and PLT were measured by automatic hematology analyzer. The prothrombin time (PT), thromboplastin Time (APTT), thrombin time (TT), fibrinogen (FIB) and D-dimer (DD) were measured. The blood pH, Degree (SaO_2). Results: 156 patients received red blood cells (489 ± 245) ml on average. No serious adverse reactions occurred during autologous blood transfusion, and postoperative recovery was good. (P <0.01). However, PT was significantly prolonged (P <0.05 or P <0.01), and D-D at the end of operation was significantly higher than that before operation (P <0.05). PaO 2 increased significantly at the end of operation and after operation (P <0.01). RBC, HGB and Hct decreased at the end of operation and after operation (P <0.01 or P <0.05). Conclusions: The recovery and transfusion of intraoperative blood loss using autologous blood collection machine can be timely recovered and transfused. It has less effect on the coagulation function and oxygen carrying capacity of patients undergoing cardiopulmonary bypass. It can effectively maintain the blood circulation and has certain clinical application value.