Klapper E, Pepkowitz S H, Czer L, Inducil C, Scott L, Goldfinger D
Rita and Taft Schreiber Division of Transfusion Medicine (Department of Pathology and Laboratory Medicine) Cedars-Sinai Medical Center, Los Angeles, Calif. 90048, USA.
J Thorac Cardiovasc Surg. 1995 Dec;110(6):1594-9. doi: 10.1016/S0022-5223(95)70018-8.
Though earlier investigations have demonstrated the efficacy of autologous blood transfusion in reducing allogeneic blood exposure in patients undergoing heart or lung transplantation, questions remain regarding the safety of blood donation by patients with severe heart or lung disease.
Response to autologous blood donation by candidates for heart and lung transplantation and a group of age- and gender-matched control subjects was studied. Heart rate, blood pressure, oxygen saturation, and cardiac rhythm were examined before and after phlebotomy, and response to orthostatic challenge was evaluated. Patients were also questioned regarding impressions of changes in subjective sense of well being. Differences between patients and control subjects were evaluated by the paired t test and Fisher's exact test. An alpha of 0.05 was used in all testing to determine statistical significance.
Eighteen candidates for heart transplantation, 16 candidates for lung transplantation, and their matched control subjects were studied. Though patients and control subjects differed with respect to baseline hemodynamic measurements, significant differences between the groups' responses to phlebotomy were not observed. After whole blood donation, orthostatic challenge resulted in a mean change in mean arterial pressure of -2.1 mm Hg in candidates for heart transplantation compared with a mean of +3.6 mm Hg in their control subjects (p = 0.062). In candidates for lung transplantation there was a mean change of +2.2 mm Hg after orthostatic challenge versus a mean change of +8.5 mm Hg in their control subjects (p = 0.052). Furthermore, no changes in cardiac rhythm or arterial oxygen saturation were detected.
The hemodynamic effects of autologous blood donation in a group of patients with significant cardiac or pulmonary disease were not different from those observed in patients considered acceptable candidates for autologous blood collection. On the basis of these objective findings, we believe that patients with less severe degrees of heart or lung disease should not be excluded from participation in autologous blood donation programs.
尽管早期研究已证明自体输血在减少心脏或肺移植患者异体血暴露方面的有效性，但对于严重心脏或肺部疾病患者献血的安全性仍存在疑问。
研究了心脏和肺移植候选人以及一组年龄和性别匹配的对照受试者对自体献血的反应。在静脉放血前后检查心率、血压、血氧饱和度和心律，并评估对直立位挑战的反应。还询问了患者关于主观幸福感变化的感受。通过配对t检验和Fisher精确检验评估患者与对照受试者之间的差异。所有测试均采用0.05的α水平来确定统计学意义。
研究了18名心脏移植候选人、16名肺移植候选人及其匹配的对照受试者。尽管患者和对照受试者在基线血流动力学测量方面存在差异，但未观察到两组对静脉放血反应的显著差异。全血捐献后，心脏移植候选人直立位挑战导致平均动脉压平均变化-2.1 mmHg，而其对照受试者平均变化+3.6 mmHg（p = 0.062）。肺移植候选人直立位挑战后平均变化为+2.2 mmHg，而其对照受试者平均变化为+8.5 mmHg（p = 0.052）。此外，未检测到心律或动脉血氧饱和度的变化。
一组患有严重心脏或肺部疾病的患者自体献血的血流动力学效应与被认为适合自体采血的患者所观察到的效应无差异。基于这些客观发现，我们认为不应将病情较轻的心脏或肺部疾病患者排除在自体献血计划之外。
