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[从麻醉学角度看目前常规采用血液保护措施的可能性——理论基础与临床实践。I. 同种输血的潜在风险;等容血液稀释]

[The present possibilities for routine use of blood-saving measures from the anesthesiologic point of view--theoretical basis and clinical practice. I. Potential risks of homologous transfusion; normovolemic hemodilution].

作者信息

Singbartl G, Schleinzer W

机构信息

Abteilung Anästhesiologie, Intensiv- und Transfusionsmedizin, ENDO-KLINIK, Hamburg.

出版信息

Anaesthesiol Reanim. 1994;19 Suppl:4-10.

PMID:8148016
Abstract

This paper, which is the first part of four, deals with the potential risks of homologous blood transfusion as well as with normovolemic hemodilution, an autologous transfusion method, which is easily to be applied and not expensive. Although the various methods of autologous transfusion are well known for many years the public discussion on the "AIDS-topic" has led to a growing interest in blood-saving measures. However, in contrast to the so-called "AIDS-topic" the potential risks of a transfusion-transmitted hepatitis as well as the immunologic effects of homologous blood are of much greater importance. Moreover, high-court-sentences give the legal background for intensifying autologous transfusion and to offer it to the patients. So far there are four autologous transfusion methods to be applied routinely: 1. normovolemic hemodilution (NHD); 2. intra- and/or postoperative blood salvage (I/PBS) with or without autologous direct-retransfusion (ADR); 3. preoperative autologous plasmapheresis (PPH); 4. preoperative autologous blood donation (ABD). Moreover, drug-induced stimulation of the erythropoiesis by means of erythropoietin and the additional (intravenous) administration of iron may become a further component among autologous transfusion methods. Normovolemic hemodilution means exchange of autologous blood versus an artificial colloid. To make sure for normovolemia is to be considered a "conditio sine qua non" for "functioning" of normovolemic hemodilution.(ABSTRACT TRUNCATED AT 250 WORDS)

摘要

本文是四部分系列文章的第一篇,探讨了同种异体输血的潜在风险以及等容血液稀释这一自体输血方法,该方法易于实施且成本不高。尽管各种自体输血方法已为人熟知多年,但关于“艾滋病话题”的公众讨论引发了人们对血液节约措施的日益关注。然而,与所谓的“艾滋病话题”相比,输血传播性肝炎的潜在风险以及同种异体血液的免疫效应更为重要。此外,高等法院的判决为加强自体输血并将其提供给患者提供了法律依据。目前有四种自体输血方法可常规应用:1. 等容血液稀释(NHD);2. 术中及/或术后血液回收(I/PBS),可进行或不进行自体直接回输(ADR);3. 术前自体血浆置换(PPH);4. 术前自体血液捐献(ABD)。此外,通过促红细胞生成素药物诱导刺激红细胞生成以及额外(静脉)补充铁剂可能成为自体输血方法中的又一组成部分。等容血液稀释是指用人工胶体置换自体血液。确保血容量正常是等容血液稀释“发挥作用”的“必要条件”。(摘要截选至250词)

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