von Segesser L K, Weiss B M, Garcia E, Turina M I
Clinic for Cardiovascular Surgery, University Hospital, Zürich, Switzerland.
J Extra Corpor Technol. 1993;25(2):47-52.
Two consecutive series of patients undergoing repair of descending thoracic and thoracoabdominal aortic aneurysms with partial cardiopulmonary bypass and low systemic heparinization (activated coagulation time: ACT greater than 180 sec) for proximal unloading and distal protection were analyzed. During the surgical procedures, thoracic shed blood was recovered either with a red cell spinning autotransfusion device (n=10) or two pump suckers and Duraflo II heparin surface coated cardiotomy reservoirs (n=10). There were 5/10 acute lesions and 1/10 ruptures for the autotransfusion group versus 5/10 acute lesions and 2/10 ruptures for the cardiotomy group (NS). Extension of aortic resection (range 1-8) was 3.6+/-1.2 for autotransfusion versus 3.5+/-1.4 for cardiotomy suction (NS). Mean number of reimplanted patches for intercostal and visceral reperfusion was 0.3+/-0.6 for autotransfusion versus 0.6+/-1.0 for cardiotomy (NS). Perfusion time was 41+/-17 min for autotransfusion versus 60+/-19 min for cardiotomy (p less than 0.05) and cross clamp time was 33+/-14 min for autotransfusion versus 43+/-17 min for cardiotomy (p less than 0.01). Total heparin dose was for 9500+/-2100 IU for autotransfusion versus 9800+/-1300 IU for cardiotomy (NS). The mean of the lowest ACTs measured during perfusion was 281+/-121 sec for autotransfusion versus 258+/-58 sec for cardiotomy (NS). The total protamine dose given was 7800+/-2100 IU for autotransfusion versus 9700+/-1900 IU for cardiotomy (p less than 0.05). The volume of washed red cells prepared was 3186+/-1318 ml for autotransfusion versus 0 for cardiotomy (p less than 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)
对两组连续接受降胸段和胸腹主动脉瘤修复术的患者进行了分析，手术采用部分体外循环和低全身肝素化（活化凝血时间：ACT大于180秒）以实现近端减压和远端保护。在手术过程中，胸段失血回收采用红细胞旋转式自体输血装置（n = 10）或两个泵吸器及Duraflo II肝素表面涂层的心内直视手术储血器（n = 10）。自体输血组有5/10例急性病变和1/10例破裂，心内直视手术组有5/10例急性病变和2/10例破裂（无显著差异）。自体输血组主动脉切除范围（1 - 8）为3.6±1.2，心内直视手术吸除组为3.5±1.4（无显著差异）。自体输血组肋间和内脏再灌注的再植入补片平均数量为0.3±0.6，心内直视手术组为0.6±1.0（无显著差异）。自体输血组灌注时间为41±17分钟，心内直视手术组为60±19分钟（p < 0.05），夹闭时间自体输血组为33±14分钟，心内直视手术组为43±17分钟（p < 0.01）。自体输血组肝素总剂量为9500±2100 IU，心内直视手术组为9800±1300 IU（无显著差异）。灌注期间测得的最低ACT平均值，自体输血组为281±121秒，心内直视手术组为258±58秒（无显著差异）。鱼精蛋白总剂量自体输血组为7800±2100 IU，心内直视手术组为9700±1900 IU（p < 0.05）。自体输血组制备的洗涤红细胞量为3186±1318毫升，心内直视手术组为0（p < 0.05）。（摘要截断于250字）
