Kongsgaard U E, Tølløfsrud S, Brosstad F, Ovrum E, Bjørnskau L
Department of Anaesthesiology, Rikshospitalet, Oslo, Norway.
Acta Anaesthesiol Scand. 1991 Jan;35(1):71-6. doi: 10.1111/j.1399-6576.1991.tb03244.x.
Fourteen patients undergoing open-heart surgery received intermittent or continuous postoperative autotransfusion of shed mediastinal blood (minimum 400 ml during 6 h after surgery) collected in the cardiotomy reservoir. Hematologic variables and changes in the coagulation, fibrinolytic and plasma kallikrein-kinin systems were investigated in the reservoir blood at the beginning and after 6 h of autotransfusion, and in patient blood during and after surgery and before and after autotransfusion. Autotransfusion volume ranged from 400 to 1200 ml per patient (median 482 ml). The reservoir blood had a median haemoglobin level of 93 and 74 g/l, a platelet count of 71 and 119 x 10(9)/l, and plasma haemoglobin level of 3110 and 4100 mg/l before and after 6 h of autotransfusion, respectively. Further examination of the reservoir blood showed that it had undergone extensive coagulation and fibrinolysis as well as a moderate activation of the kallikrein-kinin system. Despite these extensive alterations in the reservoir blood, no major change could be found in the circulating blood after autotransfusion, except for a moderate increase in plasma haemoglobin from 180 mg/l to 430 mg/l. The clinical safety and simplicity of this technique were confirmed for autotransfusion of shed mediastinal blood up to 1200 ml.
14例接受心脏直视手术的患者接受了术后间歇性或持续性自体回输术野纵隔血（术后6小时内最少400ml），这些血收集于心内直视手术贮血器中。对贮血器中的血液在自体回输开始时和回输6小时后进行了血液学变量以及凝血、纤维蛋白溶解和血浆激肽释放酶-激肽系统变化的研究，并对患者手术期间、术后以及自体回输前后的血液进行了研究。每位患者的自体回输血量为400至1200ml（中位数为482ml）。自体回输6小时前后，贮血器中血液的血红蛋白水平中位数分别为93g/l和74g/l，血小板计数分别为71×10⁹/l和119×10⁹/l，血浆血红蛋白水平分别为3110mg/l和4100mg/l。对贮血器血液的进一步检查显示，其经历了广泛的凝血和纤维蛋白溶解以及激肽释放酶-激肽系统的中度激活。尽管贮血器中的血液发生了这些广泛变化，但自体回输后循环血液中未发现重大变化，只是血浆血红蛋白从180mg/l中度增加至430mg/l。该技术用于回输最多1200ml术野纵隔血的临床安全性和简便性得到了证实。
