2023 年第 7 期 第 18 卷

枸橼酸钠抗凝回收式自体输血技术在体外循环心脏手术后出血患者中的应用

Application of sodium citrate anticoagulant salvage autologous blood transfusion in patients with bleeding after extracorporeal circulation cardiac surgery

作者：郝兴海1陈越岭2贾明1

英文作者：Hao Xinghai1 Chen Yueling2 Jia Ming1

单位：1首都医科大学附属北京安贞医院心脏外科北京市心肺血管疾病研究所，北京100029；2首都医科大学附属北京潞河医院心脏外科，北京101199

英文单位：1Department of Cardiac Surgery Beijing Anzhen Hospital Capital Medical University Beijing Institute of Heart Lung and Blood Vessel Diseases Beijing 100029 China； 2Department of Cardiac Surgery Beijing Luhe Hospital Capital Medical University Beijing 101199 China

关键词：术后出血；枸橼酸钠；回收式自体输血

英文关键词：Postoperativebleeding;Sodiumcitrate;Salvageautologousbloodtransfusion

• 摘要：

• 目的  探讨枸橼酸钠抗凝回收式自体输血技术在体外循环心脏手术后出血患者中应用的可行性和安全性。方法  选取首都医科大学附属北京安贞医院2016年7—12月术中判断可能存在术后出血风险的体外循环心脏手术患者90例，将心包纵隔引流血收集于贮血滤血器，施加负压，连续观察引流情况，根据引流速度向储血罐中加入枸橼酸钠抗凝剂，其中41例引流速度达到2 h＞400 ml或3 h＞500 ml标准，启动回收式自体输血流程，至术后12 h停止。对洗涤前后的血液成分进行检测，对患者输血前后的凝血功能和电解质水平进行检测。结果  引流血液经过洗涤、离心后，白细胞计数（WBC）和Cl-水平均高于洗涤前，血小板计数（PLT）、主要阳性电解质（K+、Na+、Ca2+）、血尿素氮、血乳酸水平均低于洗涤前，差异均有统计学意义（均P＜0.05）。白细胞、血小板、K+、血尿素氮和血乳酸的清除率分别为（42±18）%、（83±4）%、（90±3）%、（90.0±2.6）%和（93.0±2.9）%。结论  应用枸橼酸钠抗凝回收式自体输血技术在体外循环术后出血患者中，可以有效控制Ca2+浓度，达到抗凝效果，未引发凝血功能异常，红细胞回收率和杂质清除率良好，有助于改善重症监护病房患者贫血状态，是一项安全有效的患者血液管理方案。

• Objective  To investigate the feasibility and safety of sodium citrate anticoagulant salvage autologous blood transfusion in patients with bleeding after extracorporeal circulation cardiac surgery. Methods  A total of 90 patients with possible risk of postoperative bleeding who underwent cardiac surgery with cardiopulmonary bypass in Beijing Anzhen Hospital, Capital Medical University from July to December 2016 were selected. The pericardial mediastinal drainage was collected in the blood storage filter, negative pressure was applied, the drainage was continuously observed, and sodium citrate anticoagulant was added to the blood storage tank according to the drainage rate. There were 41 patients with the drainage speed reached the standard of 2 h>400 ml or 3 h>500 ml, and the salvage autologous blood transfusion process was started and stopped 12 h after operation. The blood components before and after washing were detected, and the coagulation function and electrolyte levels of the patients before and after transfusion were detected. Results  After washing and centrifugation, the white blood cell count (WBC) and Cl- levels of the drained blood were higher than those before washing, and the platelet count (PLT), main positive electrolytes (K+, Na+, Ca2+), blood urea nitrogen and blood lactic acid levels were lower than those before washing (all P<0.05). The clearance rates of white blood cell, the platelet, K+, blood urea nitrogen and blood lactic acid were (42±18)%, (83±4)%, (90±3)%, (90.0±2.6)% and (93.0±2.9)%, respectively. Conclusions    The application of sodium citrate anticoagulant salvage autologous blood transfusion technology in patients with bleeding after cardiopulmonary bypass can effectively control Ca2+ concentration, achieve anticoagulant effect, does not cause abnormal coagulation function, and has a good red blood cell recovery rate and impurity clearance rate, which is helpful to improve the anemia of patients in intensive care unit. It is a safe and effective patient blood management program.