ANH自体输血在完全性前置胎盘合并胎盘植入剖宫产术中的应用

目的:研究急性等容血液稀释(ANH)自体输血在完全性前置胎盘合并胎盘植入剖宫产术中的应用价值。方法:选择2012年1月~2015年12月在我院进行诊治的完全性前置胎盘合并胎盘植入患者80例,随机分为三组,对照组(n=26)进行常规处理,ANH组(n=27)进行急性等容血液稀释,AHH(急性高容血液稀释)组(n=27)进行急性高容血液稀释。比较三组产妇的体重、年龄、手术时间、术中出血量、输注异体血例数,ANH组和AHH组血液稀释前后和三组产妇术后的动脉血气分析值、术后2 h血常规,三组新生儿娩出后1min、5min Apgar评分及脐动脉血血气分析值。结果:血液稀释后,两组的血红蛋白、红细胞比容和碱剩余均较血液稀释前明显降低(P0.05),两组血气分析无明显差异(P0.05);ANH组输注异体血的比例明显低于AHH组和对照组(P0.05),剖宫产术后2h,ANH组的血红蛋白、红细胞比容和血小板均明显高于AHH组和对照组(P0.05);三组新生儿的血红蛋白、红细胞比容、碱剩余、血乳酸和Apgar评分均无明显差异(P0.05)。结论:ANH自体输血能减少异体血的输注和产妇剖宫术中红细胞的丢失,节约临床用血,对产妇和新生儿的影响较小。     

术中回收式自体输血与全身炎症反应研究进展

术中回收式自体输血技术被大量临床研究表明对机体是安全的、有效的,但在一些研究中发现回输的自体血中含有炎性因子,其可能对机体的全身炎症反应产生不利影响。本文就近年来有关术中回收式自体输血与全身炎症反应研究作一综述。     

剖宫产术围术期预防性应用抗生素的成本效果分析

目的:探讨剖宫产术围术期预防性应用抗生素的成本效果,为剖宫产手术提供有效、经济的抗生素应用方案。方法:选取我院近3年接诊的80例实施剖宫产产妇纳入本次研究,将其随机分为研究组和对照组,每组产妇40例。研究组在胎儿娩出断脐后立即静脉滴注头孢呋辛,术后不再应用抗生素,而对照组术后静脉滴注头孢呋辛,对比两组产妇的成本效果。结果:两组产妇术后体温(平均体温、最高体温)、体温恢复时间、住院时间和术后感染发生率对比均无统计学差异(P0.05);研究组成本效果明显低于对照组(P0.05)。结论:剖宫产术围术期预防性应用抗生素可达到良好的抗感染效果,选择头孢呋辛作为剖宫产手术围术期预防性抗菌药物,是一种有效、经济的方案,可避免围术期过度使用抗生素。     

剖宫产产妇并发医院感染的临床特征及相关影响因素研究

目的:探讨剖宫产产妇并发医院感染的临床特征及相关影响因素,并提出相应的防控措施。方法:选取自2014年1月至2016年12月间在我院妇产科进行剖宫产手术的产妇4112例,记录产妇感染发生的情况(感染率、感染部位及病原菌分布),并统计分析产妇的基本情况,包括年龄、体质量指数(BMI)、住院时间、基础疾病等基本情况。结果:进行剖宫产的产妇合并发生医院感染的感染率为4.89%(201/4112);感染部位主要为手术切口感染、泌尿道感染、生殖道感染、盆腔感染、呼吸道感染及皮肤感染,其中手术切口感染所占比例为45.77%;医院感染病例中共培养出5种病原菌共51株,包括金黄色葡萄球菌、葛兰氏阴性杆菌、副流感嗜血菌、粪肠球菌及耐甲氧西林金黄色葡萄球菌;感染因素中年龄、BMI、住院时间、基础疾病情况、医护人员操作的熟练程度、手术时间、术中出血量、术后尿管留置时间及抗菌药物应用与剖宫产产妇并发医院感染之间具有紧密联系(P0.05),而首次剖宫产手术与剖宫产产妇并发医院感染之间无联系(P0.05)。结论:剖宫产产妇并发医院感染的发生率较高,而且多种感染因素影响其发生,因此在临床上应采取相应的防控措施,降低感染率,保证产妇和新生儿的身心健康。     

不同术式的剖宫产术对再次剖宫产产妇腹腔粘连、盆腔粘连及妊娠结局的影响

目的:探讨不同术式的剖宫产术对再次剖宫产产妇腹腔粘连、盆腔粘连及妊娠结局的影响。方法:选取我院于2007年7月-2017年10月间收治的需再次行剖宫产产妇168例为研究对象。根据首次剖宫产术式分为对照组(新式腹壁横切式)92例和观察组(传统腹壁纵切式)76例。观察并比较两组产妇临床指标,盆腔粘连、腹腔粘连严重程度以及妊娠结局情况。结果:观察组产妇手术时间、胎儿娩出时间、术中出血量、住院时间、肛门排气时间均低于对照组,差异有统计学意义(P0.05)。观察组产妇腹腔粘连发生率为46.05%(35/76),显著低于对照组的77.17%(71/92),差异有统计学意义(P0.05)。观察组产妇盆腔粘连发生率为34.21%(26/76),低于对照组的54.35%(50/92),差异有统计学意义(P0.05)。两组产妇产后出血、术后切口感染、新生儿窒息等发生率比较差异无统计学意义(P0.05)。结论:首次剖宫产术式的选择对再次剖宫产产妇具有较大影响,传统腹壁纵切式可显著改善产妇临床指标情况,减少盆腔粘连、腹腔粘连发生的概率,且术后并发症较少,值得临床推广应用。     

人工关节置换术中预存式联合自体回收式输血患者免疫功能和炎症因子的变化及相关性分析

目的:探讨人工关节置换术中预存式联合自体回收式输血患者免疫功能和炎症因子水平的变化,并分析免疫功能和炎症因子的相关性。方法:选取在我院接受人工关节置换术的患者80例,根据随机数字表法将患者分为对照组和观察组。对照组患者行异体输血治疗,观察组行预存式联合自体回收式输血治疗。比较两组患者围术期失血量和输血量,分析两组患者不同时间点的免疫功能指标和炎症因子水平的变化及其相关性,统计两组患者术后出现的不良反应。结果:两组患者的术中失血量、术后失血量、总失血量和总输血量比较差异无统计学意义(P0.05)。术后24 h两组患者的CD3~+、CD4~+、CD4~+/CD8~+、自然杀伤细胞(NK)明显降低,且观察组高于对照组(P0.05),术后24 h两组患者的白细胞介素-6(IL-6)、白细胞介素-8(IL-8)、肿瘤坏死因子-α(TNF-α)水平明显升高,且观察组低于对照组(P0.05)。经Pearson相关性分析显示,IL-6、IL-8、TNF-α均与CD3~+、CD4~+、CD4~+/CD8~+、NK呈负相关(P0.05)。观察组的不良反应率低于对照组(P0.05)。结论:人工关节置换术中预存式联合自体回收式输血对患者免疫功能、炎症反应的影响较小,输血安全性较好,且患者的免疫因子和炎症因子相互制约。     

血红蛋白类血液代用品的研究现状

人体大量失血时,可引起两种致命结果:(1)血管萎陷和血压下降;(2)红细胞丢失和组织缺氧引起细胞死亡和器官衰竭。二十世纪输血治疗的成功应用无疑是一个革命性的进步,然而这项技术应用到今天暴露出了许多问题。首先输血会引起多种疾病,主要由血型错误和污染造成;其次现在自体输血或他人直接输血血源紧张,兼之红细胞寿命短,运输及保存要求条件高,很不利于战时或民用紧急输血。上述因素尤其是近来对输血引起艾滋病感染的恐惧刺激了血液代用品的     

贮存式自体输血和异体输血对老年脑外科手术患者炎症反应及T淋巴细胞亚群的影响

摘要 目的：探讨老年脑外科手术患者分别经贮存式自体输血和异体输血后,其对机体T淋巴细胞亚群和炎症反应的影响。方法：选取2017年3月~2019年10月期间我院收治的行脑外科手术老年患者150例,根据随机数字表法将患者分为对照组（n=75,异体输血）和研究组（n=75,贮存式自体输血）,对比两组围术期相关指标情况,比较两组术前、术后5d的炎症因子水平[白介素-6（IL-6）、肿瘤坏死因子-α（TNF-α）、C反应蛋白（CRP）]以及T淋巴细胞亚群变化情况,记录两组输血不良反应发生情况。结果：两组术前住院时间、术前血红蛋白比较差异无统计学意义（P>0.05）;研究组术后住院时间短于对照组,术中出血量、术中输血量少于对照组,术后血红蛋白多于对照组（P<0.05）。两组术后5d IL-6、CRP、TNF-α均升高,但研究组低于对照组（P<0.05）。两组患者术后5d CD3⁺、CD4⁺/CD8⁺、CD4⁺均降低,但研究组高于对照组,CD8⁺升高,但研究组低于对照组（P<0.05）。研究组输血不良反应发生率低于对照组（P<0.05）。结论：与异体输血应用于老年脑外科手术患者相比,贮存式自体输血效果确切,可减轻炎性应激,降低免疫抑制,同时还可减少输血不良反应发生率,节约宝贵的血液资源。     

自体血液回输技术应用于非体外循环冠状动脉旁路移植术的效果

目的探讨非体外循环冠状动脉旁路移植术(OPCAB)中应用自体血液回输技术的临床效果。方法对2017年2月～2018年2月在我院接受OPCAB治疗的85例患者的临床资料进行回顾分析。按照是否采用自体血液回输技术分为观察组(自体血回输)和对照组(未应用),观察比较两组术后24 h血常规指标水平,并测定术后引流量、异体血输注量及输血不良反应情况。结果两组患者的血红蛋白、红细胞比容、红细胞计数、血小板计数及术后引流量等指标比较,差异均无统计学意义(P0.05);观察组的异体血输注量、输血不良反应发生率显著低于对照组,差异均有统计学意义(P0.05)。结论将自体血液回输技术应用于OPCAB治疗中,可有效减少异体血输注量和输血不良反应发生,对患者血常规无明显影响,且安全性较高,值得临床应用。     

自体血回输可改善骨科手术患者血液氧合功能和降低炎性反应

为了探讨术中自体血回输对骨科手术患者围手术期血液氧合及炎性反应的影响,本研究选择骨科手术患者52例,按随机数字表法分为自体血回输组(A组, 26例)和输异体血组(B组, 26例)。A组患者在术中给予自体血液回输,B组患者术中输注同种异体血。于术前、术中输血结束时、术后24 h,通过对两组患者分别进行桡动脉采血化验血气分析,检测动脉氧分压(PaO2)、动脉血液氧含量(CaO2),并抽取外周静脉血检测2, 3-二磷酸甘油酸(2,3-DPG)、白细胞(WBC)、C反应蛋白(CRP)。本研究发现,术中输血结束时A组PaO2、CaO2、2,3-DPG高于B组,差异有统计学意义(p0.05);术后24 h,A组PaO2、CaO2、外周静脉、2,3-DPG均高于B组,但差异无统计学意义(p0.05);术中,A组WBC、CRP均比B组低,但差异无统计学意义(p0.05);A组术后24 h,WBC、CRP均比B组低,比较差异有统计学意义(p0.05)。本研究表明,自体血回输能明显改善骨科手术患者血液氧合功能和降低炎性反应。本研究为自体血回输在骨科手术中的临床应用提供了一定的理论依据。     

The use of intraoperative autotransfusion during cranial vault remodeling for craniosynostosis.

Intraoperative autotransfusion salvages blood shed during surgery for use in immediate resuscitation of the patient. The purpose of this study was to determine whether such autotransfusion decreases the volume of homologous blood transfused in patients undergoing primary cranial vault remodeling for craniosynostosis. The Cobe-Bret 2 autologous blood recovery system (Hemo Concepts, Union, N.J.) was used in 11 cases, and an equal number of consecutive cases did not receive intraoperative autotransfusion. There were no significant differences between the groups with respect to age, sex, and weight. Mean estimated blood loss was 43.2 ml/kg (range, 20.3 to 65.0 ml/kg) in the intraoperative autotransfusion group and 40.2 ml/kg (range, 6.8 to 72.3 ml/kg) in the control group (not statistically significant; p < 0.05). There was no significant difference in volume of homologous blood transfusion between the two groups. The autotransfusion group received 34.1 ml/kg of homologous blood (range, 0 to 60.7 ml/kg), and the control group received a mean of 32.7 ml/kg (range, 14.5 to 60.2 ml/kg). The autotransfusion group received a mean of 10.4 ml/kg of recovered autologous blood (range, 0 to 21.4 ml/kg). In four of the 11 autotransfusion patients, insufficient autologous blood was recovered intraoperatively to warrant transfusion. Results of this study suggest little benefit for the use of intraoperative autotransfusion in primary cranial vault remodeling for craniosynostosis in the young patient. It was hypothesized that this finding was a result of the following: (1) intraoperative autotransfusion blood was usually available only toward the end of the procedure, after homologous blood had already been administered, and (2) the volume of recovered intraoperative autotransfusion blood is minimal, compared with the homologous transfusion volume requirements during an extensive cranial vault remodeling and fronto-orbital advancement procedure. In the context of unproven cost benefit and increasing similar evidence from other comparative studies, emphasis should be directed to other medical and surgical strategies to minimize the need for perioperative blood transfusion.     

Quality of the blood sampled from surgical drainage after total hip arthroplasty

Several methods have been found to be successful in reducing the need for allogeneic transfusion among the patients undergoing total hip replacement. The purpose of this prospective study was to analyse the quality and evaluate the effect of postoperative autotransfusion on the need for allogeneic transfusion following total hip replacement. The prospective study was performed in two groups of patients undergoing total hip replacement. Before the operative procedure all patients in both groups predonated two doses of autologous blood. In GROUP 1. the system for postoperative collection and transfusion of shed blood was used. In GROUP 2. the patients underwent total hip replacement without blood salvage system. Standard suction collection sets were used postoperatively. In this group shed blood was not transfused to the patients. The samples of preoperative donated autologus blood, allogeneic blood and postoperative collected autologous blood were analysed for number of red cells, hemoglobin, hematocrit, platelets, white blood cells, values of potassium, sodium, free hemoglobin and acid base status. The postoperatively blood salvage significantly reduced the use of allogeneic transfusion among patients managed with total hip replacement (allogeneic transfusion received 12% patients in Group 1 and 80% patients in Group 2; p<0.001). The values of red blood cells are significantly lower in postoperative collected autotransfusion blood compared with preoperative collected autologous blood and allogeneic blood (p<0.001). The values of potassium and acid base status were in normal range in postoperatively collected autotransfusion blood. These values in preoperatively collected autologous blood and allogeneic blood were out of normal range; (p<0.001). In addition to reducing the risk of complications that are associated with allogeneic transfusion, postoperative blood salvage may offer benefits including reducing the need for allogeneic blood. Our study confirmed that postoperative collection and transfusion of drainaged blood is simple and safe method that significantly reduce the need for allogeneic transfusion in patients underwent total hip replacement. The blood collected and transfused postoperatively has lower values of red blood cells and normal values of potassium and acid base balance. The transfusion of this blood caused no complications in our patients.     

Hemorrhage of late pregnancy

Rupture of the uterus, cesarean section and uterine atony were the major causes of maternal death associated with hemorrhage of late pregnancy for the five years 1945 to 1949 in New York County. Shock occurred earliest in rupture of the uterus and cesarean section, while in uterine atony there was some delay before shock was evident. Placenta previa was preceded by an initial small hemorrhage, and the time interval before shock was relatively long. It appeared that in cases of retained placenta, manual removal of the organ and hysterectomy were unduly delayed. Ten per cent of the maternal deaths reviewed were associated with severe transfusion reactions. Early recognition of a serious situation, rapid blood replacement and hysterectomy might have salvaged most of the patients.     

55例自身血回收的临床应用探讨

总结和分析在心脏手术中进行自身血回收的经验。1999年1月－2000年3月,上海市胸科医院共进行自身血回收55例,其中男性27例,女性25例。年龄范围19－71岁,体表面积1．3－2．2m^2。本院应用的是意大利dideco公司生产的自身血回收机及其管道,不仅回收手术野血,而且回收体外循环管道内的残余血液。结果：55例患者均康复。自身血回收组患者的术后用血量和ICU时间与对照组相比,均显著降低（P＜0．05）。讨论：自身血回收技术除可减少患者术后用血量和ICU时间与对照组相比,均显著降低（P＜0．05）。讨论：自身回收技术除要减少患者术后用血、缓解血源紧张、避免血源性疾病外,还可提供以下有利条件：①为稀有血型患者提供手术保障;②可提供手术中发生意义大出血时的应急处理手段;③为外地患者就医和手术提供方便,并能减轻经济负担。     

Blood salvage, proper choice for tumor patients?

Blood transfusion is frequently used in tumor patients, However, allogeneic blood transfusion have been claimed to be associated with an increased risk of negative outcomes, including transfusion reactions, fever, virus transmission, and alloimmunization. Other risks of homologous transfusion specific to the tumor patients are the potential deleterious effects on the recurrence of tumor and indefinite overall survival. On the contrary, autologous blood transfusion offers survival advantages to tumor patients and has been shown to minimize the occurrence of many detrimental allogeneic blood associated effects and complications. It also reduces the volume of banked blood needed and improves the prognosis of patients. However, the quality of salvaged blood is still a matter of debate, because it may contain tumor cells which are associated with potential detrimental effects such as metastasis. So, an advanced technology is needed to remove such contaminants to make autologous blood transfusion safer.     

自体输血与异体输血对创伤性颅脑损伤开颅手术患者凝血功能、细胞免疫功能和神经损伤标志物的影响

摘要 目的：探讨自体输血与异体输血对创伤性颅脑损伤（TBI）开颅手术患者凝血功能、细胞免疫功能和神经损伤标志物的影响。方法：回顾性分析2019年4月~2022年5月期间在本院行开颅手术的120例TBI患者的临床资料。根据输血方式的不同将患者分为异体输血组（n=58,异体输血）和自体输血组（n=62,自体输血）,观察两组临床指标、细胞免疫功能、凝血功能、神经损伤标志物和不良反应发生率情况。结果：两组患者手术出血量、输血量、输注含凝血成分血制品比例对比,差异无统计学意义（P>0.05）。自体输血组出院时CD3⁺、CD4⁺、CD4⁺/CD8⁺高于异体输血组,CD8⁺低于异体输血组（P<0.05）。两组出院时凝血酶原时间（PT）、凝血酶时间（TT）、纤维蛋白原（FIB）、活化部分凝血活酶时间（APTT）组间对比无统计学差异（P>0.05）。自体输血组出院时S100钙结合蛋白B（S100B）、神经胶质原纤维酸性蛋白（GFAP）、神经元特异性烯醇化酶（NSE）低于异体输血组（P<0.05）。两组不良反应发生率组间比较无差异（P>0.05）。结论：自体输血用于TBI开颅手术患者,对患者的凝血功能影响较小,同时还可改善机体细胞免疫功能,降低神经损伤标志物水平。     

腹主动脉球囊预置术治疗凶险型前置胎盘疗效评价

目的:探讨腹主动脉球囊预置术治疗凶险型前置胎盘的疗效及安全性。方法:收取2014年3月至2016年3月我院收治的凶险型前置胎盘患者71例临床资料进行回顾性分析,观察组患者35例,行剖宫产前进行腹主动脉球囊预置术;对照组患者36例,直接进行剖宫产。对两组患者手术情况、术后情况以及新生儿情况进行观察比较。结果:两组患者手术时间及胎盘植入情况无显著差异,观察组术中出血量及输血量明显低于对照组,医疗费用明显高于对照组,产后出血及并发症发生率明显低于对照组,差异均有统计学意义(P0.05)。两组患者子宫切除率无显著差异(P0.05)。两组新生儿体质量及窒息情况无显著差异(P0.05)。结论:剖宫产前行腹主动脉球囊预置术可有效控制术中出血,是治疗凶险型前置胎盘安全有效的方法。     

急诊危重孕产妇5分钟紧急剖宫产的临床效果及新生儿不良结局的危险因素分析

摘要 目的：探讨急诊危重孕产妇5分钟紧急剖宫产的临床效果,并分析新生儿不良结局的危险因素。方法：回顾性分析2018年1月~2022年6月在河北省儿童医院妇产科收治的急诊危重孕产妇139例的临床资料。根据急诊剖宫产流程分为对照组（n=68,常规紧急剖宫产流程下进行手术）及观察组（n=71,5分钟紧急剖宫产）。观察两组孕产妇的手术情况、手术反应时间、孕产妇并发症、新生儿不良结局发生率。采用多因素Logistic回归模型分析新生儿不良结局的危险因素。结果：两组住院时间、术中出血量、术中输血情况组间对比,未见统计学差异（P>0.05）。与对照组相比,观察组进手术室至手术开始时间、决定手术至胎儿娩出的时间间隔（DDI）、决定手术至进手术室时间、手术开始至胎儿娩出时间均更短,新生儿不良结局发生率、并发症发生率更低（P<0.05）。根据新生儿不良结局将孕产妇分为不良组（n=38）、良好组（n=101）。单因素分析结果显示：新生儿不良结局与受教育程度、新生儿体重、孕周、剖宫产类型、DDI、妊娠合并症、采用辅助生殖技术有关（P<0.05）。多因素Logistic回归分析结果显示,受教育程度为小学及其以下、新生儿体重偏低、剖宫产类型为I类剖宫产、孕周偏短、DDI偏长均是新生儿不良结局的危险因素（P<0.05）。结论：急诊危重孕产妇5分钟紧急剖宫产可缩短各项手术反应时间,降低孕产妇并发症和新生儿不良结局发生率。此外,新生儿不良结局的发生与受教育程度、新生儿体重、剖宫产类型、孕周、DDI等因素有关。     

The effect of partial removal of yolk on the chilling sensitivity of zebrafish (Danio rerio) embryos

In a group of 39 patients with ischemic heart and valvular disease (January 1997 to May 1998), three platelet collection methods were compared in terms of safety and effectiveness. The methods were: (i) collection of autologous platelets over several weeks and freezing them for storage until surgery (frozen group, 12 patients); (ii) collection of autologous platelets on the day before surgery and preserving them without freezing (fresh group, 8 patients); and (iii) collection of autologous platelets intraoperatively (intraoperative group, 9 patients). Ten patients served as controls (control group). Blood pressure was not significantly affected by platelet collection in the frozen and fresh groups, but both systolic (P < 0.01) and diastolic blood pressure (P < 0.05) decreased significantly after collecting platelets in the intraoperative group. Similarly, heart rate was unaffected by platelet collection in the frozen and fresh groups, while it increased significantly in the intraoperative group (P < 0.05). Blood loss after 24 h was significantly smaller in the fresh group than in the frozen group (P < 0.05). Total blood transfusion volume was significantly smaller in the frozen and fresh groups than in the intraoperative and control groups (P < 0.05). Bleeding time 2 h postoperatively, when administration of autologous platelets had been completed, was reduced compared with immediately postoperative values in all three groups receiving autologous platelets (P < 0.05). However, only the frozen and fresh groups showed a significantly shorter bleeding time than the control group (P < 0.05). In all three groups receiving autologous platelets, the platelet count was significantly increased after administration of autologous platelets, but only the fresh group had a platelet count that was significantly greater than the control group (P < 0.05). From these results we conclude that the frozen and fresh groups received safer treatment than the intraoperative group. Although hemostasis improved after all three regimes of autologous platelet transfusion, only the frozen and fresh groups had a reduced need for allogeneic blood transfusion compared with the control group. For this reason we conclude that the frozen and fresh groups were also superior to the intraoperative group in terms of effectiveness. However, the recovery of platelets after frozen storage was low, and to obtain a good effect with the freezing method it is necessary to collect and store large volumes of platelets. In terms of simplicity, safety, and efficacy, the fresh method seems to be the preferred technique.