Ozmen V, McSwain N E, Nichols R L, Smith J, Flint L M
Department of Surgery, Tulane University School of Medicine, New Orleans, LA 70112.
J Trauma. 1992 Jan;32(1):36-9. doi: 10.1097/00005373-199201000-00008.
Increased use of autotransfusion for traumatic hemorrhage may reduce amounts of banked blood needed for severe injuries. Autotransfusion is standard for traumatic hemothorax, but has been limited for abdominal injuries. This prospective study used microbiologic data from 152 patients with intestinal injuries. Where anticipated blood loss was greater than 1,000 mL, blood from the peritoneal cavity was cultured, washed, concentrated, and recultured before reinfusion. Infection rates were stratified using the Penetrating Abdominal Trauma Index (PATI). Fifty patients with PATI greater than 20 who received banked blood (group I) (mean: 1,800 mL) were compared with 20 patients (group II) who received autotransfused, potentially culture-positive blood (CPB) (mean: 3,900 mL). Wound infection rates were identical in both groups (25%). No statistically significant increase was found in site-specific infection risk when severity of injury was stratified according to PATI. Bacteremias, pulmonary infections, and urinary infections were not caused by bacteria cultured from autotransfused blood. We conclude that washed CPB may be autotransfused without significantly increased risk of infection in patients with severe abdominal injuries.
增加创伤性出血自体输血的使用量可能会减少严重损伤所需的库存血量。自体输血是创伤性血胸的标准治疗方法，但在腹部损伤中的应用一直受到限制。这项前瞻性研究使用了152例肠损伤患者的微生物学数据。在预计失血量大于1000毫升的情况下，将腹腔内的血液进行培养、洗涤、浓缩，然后在回输前再次培养。使用穿透性腹部创伤指数（PATI）对感染率进行分层。将50例PATI大于20且接受库存血的患者（第一组）（平均：1800毫升）与20例接受自体输血、可能培养阳性血液（CPB）的患者（第二组）（平均：3900毫升）进行比较。两组的伤口感染率相同（25%）。根据PATI对损伤严重程度进行分层时，未发现特定部位感染风险有统计学意义的增加。菌血症、肺部感染和泌尿系统感染并非由自体输血血液中培养出的细菌引起。我们得出结论，对于严重腹部损伤患者，洗涤后的CPB可以进行自体输血，而不会显著增加感染风险。
