Henn A, Hoffmann R, Müller H A
Abteilung für Anaesthesie und Operative Intensivmedizin, Katharinenhospital Stuttgart.
Anaesthesist. 1988 Dec;37(12):741-5.
In addition to hemodilution, mechanical intraoperative autotransfusion (IAT) is the most important method of preventing or minimizing the transfusion of homologous blood in operations with major blood loss. Most of the problems associated with IAT could be solved by the use of cell separators, but the separated red blood cells still contain an average of 200 mg/dl free hemoglobin. By the determination of haptoglobin levels before and after IAT, we studied the effects of free hemoglobin on the patient. Seventy-seven patients with hip-joint replacement were studied. In one group, n = 47, both intraoperative blood loss and drainage blood (for 6 h post-operatively) were collected and transfused back to the patient after cell separation with the Haemonetics Cell-Saver III as a red-cell concentrate. A second group, n = 34, received only homologous blood. Serum haptoglobin was determined after anesthesia induction and after the last transfusion on the day of operation. There were no significant differences in preoperative haptoglobin levels between both groups. In the IAT group, haptoglobin was significantly lower then in the control group after transfusion (t-test, P = 0.05). In both groups 14% of the patients' haptoglobin levels were pathologic preoperatively. Post-transfusion 60% of the IAT group showed minimum levels while in another 14% no haptoglobin could be measured. In these 14%, free hemoglobin was circulating in the patients' blood because the transport capacity was exhausted. In the control group only 26.5% of the haptoglobin levels were below normal and in no case was transport capacity exhausted (Table 3). The correlation between volume of retransfused autologous blood and decrease in haptoglobin level was small (r = 0.15). In a few cases with low volumes of retransfused blood the haptoglobin decrease may have been greater, so that free hemoglobin may have been present.
除血液稀释外，机械性术中自体输血（IAT）是在大出血手术中预防或尽量减少输注异体血的最重要方法。与IAT相关的大多数问题可通过使用细胞分离器解决，但分离出的红细胞仍平均含有200mg/dl的游离血红蛋白。通过测定IAT前后的触珠蛋白水平，我们研究了游离血红蛋白对患者的影响。对77例行髋关节置换术的患者进行了研究。一组，n = 47，术中失血和引流血（术后6小时）均被收集，并用Haemonetics Cell-Saver III细胞分离器分离后作为红细胞浓缩液回输给患者。另一组，n = 34，仅接受异体血。在麻醉诱导后以及手术当天最后一次输血后测定血清触珠蛋白。两组术前触珠蛋白水平无显著差异。在IAT组，输血后触珠蛋白显著低于对照组（t检验，P = 0.05）。两组中14%的患者术前触珠蛋白水平异常。输血后，IAT组60%的患者触珠蛋白水平降至最低，另有14%的患者无法检测到触珠蛋白。在这14%的患者中，由于运输能力耗尽，游离血红蛋白在患者血液中循环。在对照组中，只有26.5%的触珠蛋白水平低于正常，且在任何情况下运输能力均未耗尽（表3）。回输自体血的量与触珠蛋白水平降低之间的相关性较小（r = 0.15）。在少数回输血量少的病例中，触珠蛋白的降低可能更大，因此可能存在游离血红蛋白。
