Ikeda S, Johnston M F, Yagi K, Gillespie K N, Schweiss J F, Homan S M
Department of Anesthesiology, St. Louis University School of Medicine, MO 63110-0250.
J Clin Anesth. 1992 Sep-Oct;4(5):359-66. doi: 10.1016/0952-8180(92)90156-u.
To analyze intraoperative autologous salvage of shed mediastinal blood and subsequent transfusion in cardiac surgery.
Retrospective statistical analysis.
University hospital.
Three thousand twenty two patients undergoing cardiac surgery from 1984 to 1988.
A review of anesthesia and transfusion records of all patients who underwent intraoperative salvage of shed blood and autologous transfusion using the Sorenson Receptal Auto Transfusion System (ATS) with saline wash prior to reinfusion in cardiac surgery.
The salvaged blood volume ranged from 36 to 2,795 ml, with a mean of 321 +/- 222 ml (SD). Eighteen percent of patients did not receive any homologous blood products during their hospitalization. Patients who received only salvaged autologous transfusion were younger, had higher preoperative hemoglobin and hematocrit values, had a larger body surface area, and had shorter surgeries compared with patients who received only homologous blood or both autologous and homologous blood. More blood products were given to patients who received salvaged autologous blood compared with those who did not. Patients who underwent normovolemic hemodilution prior to extracorporeal circulation with subsequent reinfusion received significantly fewer blood products. Ten preoperative and four intraoperative variables significantly influenced the salvaged volume. Previous cardiac surgery was the most significant preoperative variable, and repair of ventricular septal defect produced by myocardial ischemia was the most significant intraoperative variable.
Considering the average salvaged volume and its current autologous transfusion-related expense, autologous blood salvage is potentially an economic benefit. Perioperative blood conservation requires a considerable commitment from surgeons, anesthesiologists, perfusionists, and intensive care physicians to be effective.
分析心脏手术中纵隔引流血的术中自体血回收及后续输血情况。
回顾性统计分析。
大学医院。
1984年至1988年接受心脏手术的3022例患者。
回顾所有在心脏手术中使用索伦森Receptal自动输血系统（ATS）进行术中失血回收和自体输血且在回输前用盐水冲洗的患者的麻醉和输血记录。
回收血量为36至2795毫升，平均为321±222毫升（标准差）。18%的患者在住院期间未接受任何异体血制品。与仅接受异体血或同时接受自体血和异体血的患者相比，仅接受回收自体输血的患者更年轻，术前血红蛋白和血细胞比容值更高，体表面积更大，手术时间更短。与未接受回收自体血的患者相比，接受回收自体血的患者接受的血制品更多。在体外循环前进行等容血液稀释并随后回输的患者接受的血制品明显更少。十个术前变量和四个术中变量对回收血量有显著影响。既往心脏手术是最显著的术前变量，心肌缺血导致的室间隔缺损修补是最显著的术中变量。
考虑到平均回收血量及其当前与自体输血相关的费用，自体血回收可能具有经济效益。围手术期血液保护需要外科医生、麻醉医生、灌注师和重症监护医生做出相当大的努力才能有效。
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