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Analysis of risk factors of intraoperative blood transfusion during liver transplantation

ObjectiveTo explore risk factors of blood transfusion during liver transplantation and construct its prediction model. MethodsThe patients underwent liver transplantation who met the inclusion and exclusion criteria of this study from March 2020 to December 2020 in the Beijing Youan Hospital of Capital Medical University were retrospectively collected. The univariate and logistic multivariate analysis were used to evaluate the risk factors of blood transfusion during liver transplantation and construct the prediction model for intraoperative blood transfusion. ResultsA total of 151 eligible liver transplantation patients were collected in this study, including 51 non-transfusion patients and 100 transfusion patients. The univariate analysis results showed that the differences of primary diagnosis, preoperative hemoglobin (Hb), platelet count, prothrombin time, international normalized ratio, Child-Turcotte-Pugh score, and end-stage liver disease (MELD) score were statistically different between them (P<0.05). The above variables selected by the univariate analysis were selected by stepwise method, then the preoperative Hb and MELD score were selected into the multivariate logistic regression analysis, the results showed that the preoperative Hb≤113 g/L and MELD score ＞14 increased the risk of blood transfusion during liver transplantation [Hb: OR=6.652, 95%CI (2.282, 19.392), P<0.001; MELD score: OR=16.037, 95%CI (6.336, 40.592), P<0.001]. The logistic regression model predicted the area under receiver operating characteristic curve was 0.873 [95%CI (0.808, 0.919), P<0.001], the sensitivity and specificity were 91.0% and 67.5%, respectively, Youden index was 0.674, the accuracy was 86.1%. ConclusionsResults of this study suggest that preoperative Hb ≤113 g/L and MELD score＞14 increase risk of blood transfusion during liver transplantation. Logistic regression model constructed according to preoperative Hb and MELD score has a better sensitivity and specificity of intraoperative blood transfusion.

抗c和抗E抗体引起配血不合一例

目的　检测对临床输血有意义的不规则抗体，保证输血安全。 方法　检测对临床输血有意义的不规则抗体，保证输血安全。 结果　患者血型为O型，CCDee，血清含抗c、抗E抗体，选择不含c、E抗原的献血者悬浮红细胞交叉配血并输注，无任何不良反应发生。 结论　在输血前血型血清学试验中，抗体筛选对检测抗c、抗E等临床有意义的不规则抗体，对有效避免溶血性输血反应的发生有重要意义。

老年纵隔肿瘤患者 ABO 血型正反定型不一致一例

弹簧秤在儿童术中输血计量中的应用

目的 探讨弹簧秤在儿童术中输血计量中的应用效果。 方法 2016 年 8 月 1 日—9 月 15 日对 77 例需要进行术中静脉输血的患儿施行以下措施：将弹簧秤悬挂于输血袋上，通过弹簧秤称重计算患儿输血量及速度。输血前后进行血红蛋白检测，输血后患儿血红蛋白到达正常范围（儿童血红蛋白正常值为 110～160 g/L）为输血有效。 结果 77 例患儿输血后均未发生心肺功能异常、急性肺水肿及输血相关不良反应，输血有效率达到 97.4%。77 例患儿输血前后血红蛋白水平分别为（70.03±3.09）、（113.46±7.58）g/L，差异有统计学意义（t=3.58，P<0.01）。 结论 使用弹簧秤能较为准确地记录患儿术中输血量及输血速度，达到预期输血效果，保证输血安全，且简单易实施。

Expression of Cytokine-Induced Neutrophil Chemoattractant-1 in Rats with Transfusion-Related Acute Lung Injury

ObjectiveTo study the expression of cytokine-induced neutrophil chemoattractant-1(CINC-1)in rats with transfusion-related acute lung injury(TRALI),explore its possible role in the pathogenesis of TRALI. MethodsSixty Sprague-Dawley rats were randomly divided into a normal control group with sham operation,a positive control group with ALI induced by intravenous infusion of lipopolysaccharide(5 mg/kg),and a TRALI group treated by intraperitoneal injection of LPS 2h before the transfusion of human plasma (1mL),a LPS control group treated by intraperitoneal injection of LPS 2h before the transfusion of normal saline(1mL).The reverse transcription-polymerase chain (RT-PCR)was used to detect CINC-1 mRNA.The level of CINC-1 in lung tissue homogenate was measured by ELISA.Morphological changes of the lung tissue were observed under light microscope.Myeloperoxidase (MPO)in lung homogenate and wet lung weight to dry lung weight ratio (W/D)were observed.The number of cells and the percentage of polymorphonuclear neutrophil (PMN)in Bronchoalveolar lavage fluid (BALF)were also compared. ResultsCompared with the normal control group and the LPS control group,the expression of CINC-1 protein and CINC-1 mRNA were increased significantly in lung of the positive control group and the TRALI group(P<0.05).The number of cells and the percentage of PMN in BALF of the TRALI group [(310.63±76.67)×106/L and (33.57±11.51)%] were significantly higher than those in BALF of the normal control group [(101.36±63.83)×106/L and (9.87±3.56)%](P<0.05).Tissue water content and MPO activity in the TRALI group were significantly higher than those in the normal control group (P<0.05). ConclusionExpression of CINC-1 protein and CINC-1 mRNA are increased in the rat lung with TRALI and PMN infiltration in lung tissue,which suggests CINC-1 participate in the process of the PMN and endothelial cell adhesion and may play an important role in the pathogeneses of TRALI.

Application of Autobloodtransfusion Technique During Operation on Massive Haemorrhage

目的:探讨自体血液回收技术对循环、血细胞和凝血功能的影响及应用效果。方法: 选择急诊大失血手术患者27例,采用ZITI-2000型血液回收机回收血液,经过滤、离心、清洗后回输给患者。分不同时点观察HR、SBP、MAP、DBP、SPO2的变化,并监测RBC、Plt、HB、Hct、FIB、PT、APTT的变化。计算输血量和异体输血率。随机选择8例进行回收原血和回输 血血细胞学比较。结果:(1)术前血压较低,心率较快,回输血液后,HR显著降低(Plt;0.01),SBP和MAP显著升高(Plt;0.01)。(2)术前RBC、HB和Hct均低于正常水平,回输后各时点均升高明显(Plt;0.01)。术前FIB和Plt低于正常水平,回输后各时点增高,但无显著意义。PT、APTT无明显变化。(3)回收原血平均每例3735mL,回输血平均每例1589mL,异体输血率为25％。(4)回输血RBC、HB和Hct均显著高于回收原血(Plt;0.01)。结论:自体血液回收技术用于临床安全可靠,能有效维持循环的稳定,对凝血功能无明显影响,节约血源,减少异体输血。

无创脉搏血红蛋白监测技术的研究进展

抽取患者血液进行检测是监测血红蛋白浓度最常用的方法。脉搏碳氧血氧测量仪可以通过无创的方式检测连续脉搏血红蛋白。连续脉搏血红蛋白的研究有利于加强血红蛋白监测，指导早期的输血治疗，提高患者的安全。现综述连续脉搏血红蛋白在各种临床情况下的准确性以及可能的影响因素，从而探讨其在临床中的应用价值。

Application of Continuous Quality Improvement to Reduce the Nursing Record Defects for Blood Transfusion

ObjectiveTo analyze and reduce the defects in nursing records for blood transfusion by continuous quality improvement (CQI) method, in order to prevent blood transfusion related medical disputes. MethodsIn October 2014, CQI team was established to analyze the reason for transfusion record defects and make standardized process and quality monitoring forms for nursing record of blood transfusion. Six months after the implementation of CQI, 40 records were randomly selected before the CQI implementation (April to September 2014) and after the implementation (April to September 2015) for comparison and analysis. ResultAfter 6 months of implementation of CQI, nursing record defects of blood transfusion decreased significantly from 228 to 55 items. ConclusionUsing CQI method can effectively reduce nursing record defects of blood transfusion. CQI can also improve the quality of nursing records and prevent medical disputes caused by blood transfusion.

输血并发症研究的新进展

输血是一种重要的临床治疗手段。但合理的输血一直是个难点，大量输血有可能导致一系列的输血不良反应，如何有效地进行输血管理并降低输血的风险一直是国内外学者重点探讨的课题。在大量参考国内外输血管理和并发症相关文献基础上，现对近年来输血并发症新的认识作一综述。

PERIOPERATIVE BLOOD MANAGEMENT STRATEGIES FOR JOINT ARTHROPLASTY

ObjectiveTo summarize the perioperative blood management strategies for joint arthroplasty. MethodsThe literature concerning preoperative, intraoperative, and postoperative blood management was reviewed and summarized. ResultsAt present, a variety of blood management and conservation strategies are available. Preoperative strategies include iron supplementation, erythropoietin (EPO), and preoperative autologous donation (PAD). Intraoperative options include acute normovolemic hemodilution (ANH), antifibrinolytics, and the use of a tourniquet. Postoperative strategies include the use of reinfusion systems and guided transfusion protocols. Preoperatively, administration of either simple EPO or a combination of EPO and PAD can be efficacious in anemic patients. Intraoperatively, tourniquet use and tranexamic acid can effectively control bleeding. Postoperatively, appropriate transfusion indications can avoid unnecessary blood transfusions. ConclusionPerioperative blood management strategies for joint arthroplasty should be integrated for the individual patient using a variety of ways to reduce perioperative blood loss and blood transfusion, and promote the rehabilitation of patients.