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。
ObjectiveTo explore risk factors of blood transfusion during liver transplantation and construct its prediction model. MethodsThe patients underwent liver transplantation who met the inclusion and exclusion criteria of this study from March 2020 to December 2020 in the Beijing Youan Hospital of Capital Medical University were retrospectively collected. The univariate and logistic multivariate analysis were used to evaluate the risk factors of blood transfusion during liver transplantation and construct the prediction model for intraoperative blood transfusion. ResultsA total of 151 eligible liver transplantation patients were collected in this study, including 51 non-transfusion patients and 100 transfusion patients. The univariate analysis results showed that the differences of primary diagnosis, preoperative hemoglobin (Hb), platelet count, prothrombin time, international normalized ratio, Child-Turcotte-Pugh score, and end-stage liver disease (MELD) score were statistically different between them (P<0.05). The above variables selected by the univariate analysis were selected by stepwise method, then the preoperative Hb and MELD score were selected into the multivariate logistic regression analysis, the results showed that the preoperative Hb≤113 g/L and MELD score ＞14 increased the risk of blood transfusion during liver transplantation [Hb: OR=6.652, 95%CI (2.282, 19.392), P<0.001; MELD score: OR=16.037, 95%CI (6.336, 40.592), P<0.001]. The logistic regression model predicted the area under receiver operating characteristic curve was 0.873 [95%CI (0.808, 0.919), P<0.001], the sensitivity and specificity were 91.0% and 67.5%, respectively, Youden index was 0.674, the accuracy was 86.1%. ConclusionsResults of this study suggest that preoperative Hb ≤113 g/L and MELD score＞14 increase risk of blood transfusion during liver transplantation. Logistic regression model constructed according to preoperative Hb and MELD score has a better sensitivity and specificity of intraoperative blood transfusion.
目的:分析输血反应类型,分布及概率。方法:回顾性分析我院2008年11月至2009年4月各类输血事件,收集输血不良反应回报单,进行统计分析。结果:在共计8996人次输血中,发生输血不良反应47人次,其中输注血浆引起的输血不良反应率为0.68％,输注红细胞悬液的不良反应率为0.30％,总的输血不良反应率0.98％,不同血液制品输血不良反应发生率具显著性差异(Plt;0.05)。其中主要表现为过敏反应,占63％,其次为发热反应.结论:如何提高临床科室科学合理用血水平的方法需进一步探讨。
Objective To investigate the risk factors of perioperative red blood cells transfusion for coronary artery bypass grafting (CABG) surgery. Method We retrospectively analyzed the clinical data of 534 patients underwent CABG in our hospital from January to March 2014 year. Those patients were divided into two groups:an on-pump coronary artery bypass grafting group (on-pump group) and an off-pump coronary artery bypass grafting group (off-pump group). There were 185 males and 54 females with a mean age of 59.1±9.4 years in the on-pump group. There were 233 males and 62 females with a mean age of 60.3±8.5 years in the off-pump group. Preoperative data, the relative parameters of extracorporeal circulation, the quantity of red blood cells transfusion of those two groups were compared. risk factors associated with red blood cells transfusion were evaluated by multivariate logistic regression analysis. Results The risk factors of perioperative red blood cells transfusion were age (OR=1.04, 95% CI 1.02-1.07, P=0.001) , weight (OR=0.95, 95% CI 0.93-0.97, P<0.001) , smoking (OR=0.61, 95% CI 0.39-0.94, P=0.027) , preoperative level of HCT (OR=0.90, 95% CI 0.85-0.96, P=0.001) and cardiopulmonary bypass (CPB) (OR=4.90, 95% CI 3.11-7.71, P<0.001) . During CPB, the nadir hemoglobin (nHb) (OR=0.63, 95% CI 0.47-0.84, P=0.002) was the only independent risk factor of red blood cell transfusion. Conclusions Age, weight, non-smoking, preoperative level of HCT, CPB are the risk factors for patients underwent CABG perioperatively and the lowest level of Hb in CPB is an independent risk factor of perioperative red blood cells transfusion.
Objective [WTBZ]To assess the impact of dual antiplatelet therapy using aspirin and clopidogrel on postoperative bleeding and blood transfusion early after coronary artery bypass grafting (CABG). Methods [WTBZ]In this randomized controlled trial, 249 patients were randomly assigned to 2 groups after coronary artery bypass grafting from December 2007 to December 2008. Daily clopidogrel (75 mg) and aspirin (100 mg) were initiated in 124 patients (group AC) while aspirin (100 mg) alone was administered to 125 patients (group A). Antiplatelet therapy was initiated within 48h postoperatively. Demographic, operative, and postoperative data were compared between the two groups. Chest tube drainage and quantity of blood products used in both groups were recorded. The effects of the antiplatelet regimen on chest tube drainage were compared using a linear regression model. Results [WTBZ]No statistical difference of demographic, operative, and preoperative data was observed between the two groups （Pgt;0.05）. Chest tube drainage after patients received ntiplatelet agents was not significantly different between group A and group AC（495.00±270.89 ml vs. 489.25±316.68ml，t=0.146, P=0.884）. No statistical difference of cases of transfusion(81 cases vs. 91 cases，χ2=1.937, P=0.164) or quantity of red cells (2.51±2.88 U vs. 2.25±2.87 U, t=0.690, P=0.491) and plasma (195.45±300.88 ml vs. 223.01±238.68 ml,t=0.759, P=0.449) transfused was found between group A and group AC. No perioperative mortality, reexploration or extrathoracic bleeding occurred in either group. Early postoperative use of dual antiplatelet therapy was not associated with increased bleeding after coronary artery bypass grafting on multivariable analysis（r=2.297，95%CI:-64.526,69.121，P=0.946）. Conclusionpresent study suggests that according to a predefined administration protocol, dual antiplatelet therapy of aspirin and clopidogrel can safely be administered in the early postoperative period in CABG patients, without increasing the risk of bleeding complications.
ObjectiveTo study the expression of cytokine-induced neutrophil chemoattractant-1(CINC-1)in rats with transfusion-related acute lung injury(TRALI),explore its possible role in the pathogenesis of TRALI. MethodsSixty Sprague-Dawley rats were randomly divided into a normal control group with sham operation,a positive control group with ALI induced by intravenous infusion of lipopolysaccharide(5 mg/kg),and a TRALI group treated by intraperitoneal injection of LPS 2h before the transfusion of human plasma (1mL),a LPS control group treated by intraperitoneal injection of LPS 2h before the transfusion of normal saline(1mL).The reverse transcription-polymerase chain (RT-PCR)was used to detect CINC-1 mRNA.The level of CINC-1 in lung tissue homogenate was measured by ELISA.Morphological changes of the lung tissue were observed under light microscope.Myeloperoxidase (MPO)in lung homogenate and wet lung weight to dry lung weight ratio (W/D)were observed.The number of cells and the percentage of polymorphonuclear neutrophil (PMN)in Bronchoalveolar lavage fluid (BALF)were also compared. ResultsCompared with the normal control group and the LPS control group,the expression of CINC-1 protein and CINC-1 mRNA were increased significantly in lung of the positive control group and the TRALI group(P<0.05).The number of cells and the percentage of PMN in BALF of the TRALI group [(310.63±76.67)×106/L and (33.57±11.51)%] were significantly higher than those in BALF of the normal control group [(101.36±63.83)×106/L and (9.87±3.56)%](P<0.05).Tissue water content and MPO activity in the TRALI group were significantly higher than those in the normal control group (P<0.05). ConclusionExpression of CINC-1 protein and CINC-1 mRNA are increased in the rat lung with TRALI and PMN infiltration in lung tissue,which suggests CINC-1 participate in the process of the PMN and endothelial cell adhesion and may play an important role in the pathogeneses of TRALI.
ObjectiveTo explore modified methods and outcomes of collection of donor blood from donation after citizen death (DCD). MethodThe clinicopathologic data of 26 DCD donors underwent phase Ⅰ clinical trials and 6 patients who received donor blood by modified collection technique from May 2020 to November 2021 in the West China Hospital of Sichuan University were collected retrospectively. ResultsCompared with the data of 26 DCD donors at phase Ⅰ clinical trials, after the modified collection technique, the blood collection volume, the concentrated red blood cells following filtration, centrifugation, and the amount of concentrated red blood cell/kg body mass were more (P<0.05). In addition, compared with the components of stored red blood cell suspension, the pH value, sodium and chloride ions concentrations of the red blood cell suspension obtained after modified collection technique were higher (P<0.05), the potassium ion concentration was <1 mmol/L, and the lactic acid concentration of none of blood was >15 mmol/L. ConclusionThe adoption of the modified collection technique increases the amount of donor red blood collected, and its biochemical and electrolyte indicators are more in line with physiological requirements than those of stored blood.