Fuller J A, Buxton B F, Picken J, Harris R A, Davies M J
Open Heart Surgical Unit, Epworth Hospital, Richmond, VIC.
Med J Aust. 1991 Jun 3;154(11):737-40. doi: 10.5694/j.1326-5377.1991.tb121312.x.
To explore the risk of inducing a coagulation defect in cardiac surgery patients by the reinfusion of mediastinal blood.
Ten patients who underwent coronary artery surgery were prospectively studied for the haematological effects of reinfusion of blood drained from the chest drain tubes after the operation by a Sorenson autologous transfusion system.
Surgery was performed at a private hospital and patient selection was made at the time of reinfusion.
Nine patients had primary coronary artery surgery and one had a reoperation.
Blood samples were taken from the patients before reinfusion, one hour after reinfusion, and 24 hours later as well as from the collected blood. Measurements were made of the haemoglobin content, white cell and platelet counts, fibrinogen and fibrinogen degradation products, D-dimer, antithrombin III and plasma haemoglobin content. Estimations were also made of the prothrombin time, the thrombin clotting time and the activated partial thromboplastin time. The hypothesis to be tested by this study was that the reinfusion of mediastinal blood after the operation did not cause any significant disturbance of the patient's blood clotting profile.
An average of 535 mL (range, 400-950 mL) was reinfused after a period of three hours drainage (range, 45 minutes to 5 hours). While the initial patient samples contained a raised plasma haemoglobin level (0.19 g/L) significantly related to the cardiopulmonary bypass time (P less than 0.001), these were free of fibrinogen degradation products except for a sample from one patient who had a reoperation. The blood drained by the Sorenson system was lower in haemoglobin content (7.7 g/dL), and had a significant content of fibrinogen degradation products (147 mg/L) and D-dimer (6.4 mg/L) together with reduced clotting factors when compared with the patients' blood. After reinfusion, the patient sample showed evidence of altered coagulation with mildly increased clotting times (activated partial thromboplastin time 57 s, thrombin clotting time 123 s), the extent of which was related to the volume reinfused (P less than 0.001), but 24 hours later, these effects had all disappeared. All samples were sterile in aerobic and anaerobic culture media.
We conclude that the Sorenson system of retrieval of mediastinal blood after cardiac surgery provides a safe and simple method of blood conservation provided that the volume of reinfusion is not excessive.
探讨心脏手术患者回输纵隔血导致凝血功能缺陷的风险。
对10例行冠状动脉手术的患者进行前瞻性研究，观察使用索伦森自体输血系统回输术后胸腔引流管引出的血液对血液学的影响。
在一家私立医院进行手术，回输时进行患者选择。
9例患者接受初次冠状动脉手术，1例接受再次手术。
在回输前、回输后1小时、24小时以及收集的血液中采集患者血样。检测血红蛋白含量、白细胞和血小板计数、纤维蛋白原及纤维蛋白原降解产物、D - 二聚体、抗凝血酶III和血浆血红蛋白含量。还测定凝血酶原时间、凝血酶凝血时间和活化部分凝血活酶时间。本研究要检验的假设是，术后回输纵隔血不会引起患者凝血指标的任何显著紊乱。
引流3小时（范围45分钟至5小时）后平均回输535 mL（范围400 - 950 mL）。虽然最初患者血样中血浆血红蛋白水平升高（0.19 g/L），且与体外循环时间显著相关（P < 0.001），但除1例再次手术患者的血样外，这些血样中均无纤维蛋白原降解产物。与患者血液相比，索伦森系统引出的血液血红蛋白含量较低（7.7 g/dL），纤维蛋白原降解产物含量显著（147 mg/L），D - 二聚体含量为（6.4 mg/L），凝血因子减少。回输后，患者血样显示凝血改变，凝血时间轻度延长（活化部分凝血活酶时间57秒，凝血酶凝血时间123秒），其程度与回输量相关（P < 0.001），但24小时后，这些影响均消失。所有样本在需氧和厌氧培养基中均无菌。
我们得出结论，心脏手术后使用索伦森系统回收纵隔血提供了一种安全、简单的血液保存方法，前提是回输量不过大。
