Garry B, Lisman S, Wurm W H
Department of Anesthesia, New England Medical Center, Boston, MA 02111.
Can J Anaesth. 1993 Aug;40(8):791-5. doi: 10.1007/BF03009776.
Aortic aneurysm resection is frequently associated with considerable blood loss and requires transfusion. To minimize complications and cost many institutions use a "cell saving" method that allows reinfusion of the washed red cell fraction of blood suctioned from the operative field. The disadvantages of this technique are that homologous transfusion is regularly required to replace platelets and coagulation factors. Red cell transfusion may also be required when there is rapid major blood loss as the wash cycle may be too long to subject a patient, in a high-risk group for coronary artery disease, to anaemia. A new autoinfusion device anticoagulates blood as it is suctioned from the operative field then filters, defoams, and returns it whole to the patient without a processing time lapse. We successfully used the device in a patient for aortic aneurysm resection to reinfuse two-thirds of his blood volume shed over 80 min. Neither banked red cells nor plasma were used. His haematocrit and coagulation profile remained stable throughout surgery and recovery. The potential complications and cost of homologous transfusion were avoided.
主动脉瘤切除术常常伴随着大量失血，需要输血。为了将并发症和成本降至最低，许多机构采用“细胞保存”方法，该方法允许将从手术区域吸出的血液中的洗涤红细胞成分回输。这种技术的缺点是经常需要进行同种输血来补充血小板和凝血因子。当出现快速大量失血时，也可能需要输注红细胞，因为洗涤周期可能过长，使处于冠状动脉疾病高危组的患者出现贫血。一种新的自动输注装置在从手术区域吸出血液时对其进行抗凝，然后过滤、消泡，并将全血立即回输给患者，中间没有处理时间间隔。我们成功地在一名接受主动脉瘤切除术的患者中使用了该装置，回输了他在80分钟内流失的三分之二血容量。既未使用库存红细胞，也未使用血浆。在整个手术和恢复过程中，他的血细胞比容和凝血指标保持稳定。避免了同种输血的潜在并发症和成本。
