Schmidt H, Kongsgaard U, Kofstad J, Geiran O, Refsum H E
Department of Anaesthesia, Rikshospitalet, Oslo, Norway.
Acta Anaesthesiol Scand. 1995 Aug;39(6):754-8. doi: 10.1111/j.1399-6576.1995.tb04165.x.
Autotransfusion of mediastinal shed blood after open heart surgery has become a common and accepted procedure in reducing the need for homologous transfusion during the last 15 years. The objectives of the present study were to investigate the oxygen delivery capacity of autotransfused shed mediastinal blood, compared to patient-blood, during cardiopulmonary bypass and in the postoperative period. Ten consecutive patients undergoing elective cardiac surgery were studied. Mediastinal shed blood was collected in the cardiotomy reservoir and retransfused during the first 18 postoperative hours. The oxygen delivery capacity of the blood to the tissues was calculated by use of the oxygen status algorithm (OSA 2.0) programme and measurement of the 2,3-diphosphoglycerate (2,3-DPG) concentration. Autotransfusion volume ranged from 450-1530 ml per patient (median 824 ml). Shed blood had a mean haemoglobin level of 8.8 g/dl and 7.4 g/dl at 1 h and 6 h of autotransfusion, respectively. There were no significant changes of 2,3-DPG concentration in the patient-blood during cardiopulmonary bypass or after autotransfusion compared to preoperative values. P50 for oxygen (3.6 and 3.6 kPa) and 2,3-DPG concentrations (5.3 and 5.1 mikromol/ml erythrocyte) in shed mediastinal blood (1h and 6h postoperatively) were not significantly different compared to patient-blood. The results demonstrate that the oxygen delivery capacity of shed mediastinal blood is maintained and that the oxygen affinity of patient-blood is not influenced by autotransfusion.
在过去15年里，心脏直视手术后纵隔引流血的自体输血已成为一种常见且被认可的减少同种异体输血需求的方法。本研究的目的是在体外循环期间和术后，将自体回输的纵隔引流血与患者自身血液相比，研究其氧输送能力。对连续10例接受择期心脏手术的患者进行了研究。纵隔引流血收集于心内直视手术储血器中，并在术后最初18小时内回输。通过使用氧状态算法（OSA 2.0）程序并测量2,3-二磷酸甘油酸（2,3-DPG）浓度来计算血液向组织的氧输送能力。每位患者的自体输血量为450 - 1530 ml（中位数824 ml）。引流血在自体输血1小时和6小时时的平均血红蛋白水平分别为8.8 g/dl和7.4 g/dl。与术前值相比，患者血液在体外循环期间或自体输血后2,3-DPG浓度无显著变化。纵隔引流血（术后1小时和6小时）的氧分压（P50）（3.6和3.6 kPa）和2,3-DPG浓度（5.3和5.1微摩尔/毫升红细胞）与患者自身血液相比无显著差异。结果表明，纵隔引流血的氧输送能力得以维持，且患者自身血液的氧亲和力不受自体输血影响。
