Iserson K V, Knauf M A, Anhalt D
Section of Emergency Medicine, University of Arizona College of Medicine, Tucson.
Crit Care Med. 1990 Oct;18(10):1138-41. doi: 10.1097/00003246-199010000-00017.
The technique of rapid admixture blood warming of cold erythrocyte units is designed to warm erythrocyte units rapidly (less than 30 sec) while simultaneously providing saline for dilution. However, questions have been raised about the recommended use of a standard 250-ml bolus of 70 degrees C admixture saline, the uniformity and speed of blood unit warming, the difficulties inherent in keeping saline bags at 70 degrees C, and the safety of the methodology. To answer these questions, a series of tests were performed and modifications of the technique were introduced. The mean weight of 1000 successive units of erythrocytes for adult infusion was 305 g (range 220 to 410). The maximum temperature was 44 degrees C, using an internal temperature probe (1-cm temperature gradations; 2-sec recording intervals) when the smallest unit was admixed with a 250 ml 70 degrees C saline bolus; the largest unit had a minimum temperature of 30 degrees C. Plasma Hgb, osmotic fragility, and K of the minimum size erythrocyte unit showed no significant deviation from its control. Both thermographic photographs and the internal temperature recordings of the erythrocyte units demonstrated that solely due to fluid turbulence, uniform mixing occurs within approximately 30 sec of beginning the admixture process. Inverting the blood units caused a thermal layering of fluids and an unacceptable maximum blood temperature of 50 degrees C. There was no difference between the mixing time or efficacy in the presence of standard or large-bore iv tubing or additional in-line filters. Volumes of the 250-ml saline bags for admixture decreased markedly with deviations in electrolyte composition after greater than 2 wk at 70 degrees C.(ABSTRACT TRUNCATED AT 250 WORDS)
冷红细胞单位快速混合血液加温技术旨在快速加温红细胞单位（少于30秒），同时提供生理盐水用于稀释。然而，对于推荐使用的250毫升70摄氏度混合生理盐水大剂量推注、血液单位加温的均匀性和速度、将生理盐水袋保持在70摄氏度所固有的困难以及该方法的安全性等问题，人们提出了质疑。为回答这些问题，进行了一系列测试并对该技术进行了改进。用于成人输注的1000个连续红细胞单位的平均重量为305克（范围为220至410克）。当最小的单位与250毫升70摄氏度生理盐水大剂量推注混合时，使用内部温度探头（1厘米温度梯度；2秒记录间隔），最高温度为44摄氏度；最大的单位最低温度为30摄氏度。最小尺寸红细胞单位的血浆血红蛋白、渗透脆性和钾与对照相比无显著偏差。红细胞单位的热成像照片和内部温度记录均表明，仅由于液体湍流，在混合过程开始后约30秒内就会发生均匀混合。倒置血液单位会导致液体热分层，且血液最高温度达到不可接受的50摄氏度。在使用标准或大口径静脉输液管或额外的在线过滤器的情况下，混合时间或效果没有差异。在70摄氏度下放置超过2周后，用于混合的250毫升生理盐水袋的体积随着电解质成分的偏差而显著减少。（摘要截短于250字）
