OBJECTIVE: To observe the clinical results in the anterior stabile operation of spinal fracture using red blood salvage. METHODS: Nineteen cases with spinal fracture were performed the anterior decompress operation. Blood cell salvage were used during operation. Other 20 cases were also reviewed as control group, who were received the same operation without blood cell salvage. RESULTS: In the 19 cases, average volume of autologous transfusion was 536 ml. Only two cases had homologous transfusion requirements. In the control group, all cases needed homologous transfusion (averaged 947 ml). CONCLUSION: In the anterior decompress operation, the intraoperative blood salvage is highly effective in reducing transfusion and also improves the security of operation
【Abstract】Objective To investigate the effect of donor blood transfusion on inducing pancreatic allograft tolerance in outbred rat model. Methods Wistar male rats were used as blood and pancreas donor, and diabetic recipients. One ml of donor blood injected into abdomen of diabetic recipients on the day of transplantation and azathioprine given 2 days pretransplant and continued for three days. Results Pancreas allograft survival was significantly prolonged (28 to 112 days, media survival time 64.2 days). One ml of donor blood alone injected into the abdomen and azathioprine given alone 2 days pretransplant did not improve allograft survival (media survival time 9.8 vs 10.2 days). Conclusion Donor blood injected on the day of transplantation and a 3 days course of azathioprine started 2 days pretransplant have b synergism in inducing long term graft survival in this rat model.
Postoperative bleeding and coagulation hemothorax is the primary cause for re-operation after general thoracic surgical procedures. We should do a good job in the assessment of preoperative factors to increase the operation control. This article mainly introduces the thoracic surgery bleeding quantitative assessment, bleeding location and cause, hemostasis, transfusion trigger, pleural drainage tube selection, surgical complications, enhanced recovery after surgery and so on.
ObjectiveTo investigate the correlation between perioperative blood transfusion and hepatic postoperative infection. MethodsOne hundred and thirty patients undergoing hepatic operation were analyzed retrospectively on the relation of perioperative blood transfusion with postoperative infective morbidity and mortality in the period 1989-1999. The patients were divided into blood transfused group and nontransfused group. The major or minor hepatectomy was performed in 53 patients with hepatic malignancy and benign diseases. ResultsIn the blood transfused group, the infective morbidity and perioperative mortality rate was 38.5% and 16.7% respectively, significantly higher than those in nontransfused group (11.5% and 3.8% respectively), P＜0.05. The total lymphocyte count was lower in transfused group than that in nontransfused group. The postoperative antibiotics used time and length of hospital stay were (9.7±4.2) days and (18.7±13.1) days respectively in transfused group than those in nontransfused group (5.3±2.3) days and (12.7±5.2) days respectively. ConclusionThe results suggest that hepatic postoperative infective morbidity and mortality are related with perioperative blood transfusion. Any strategy to reduce blood loss in liver surgery and decrease blood transfusion would be helpful to lower postoperative infective morbidity.
ObjectiveTo systematically evaluate the risk factors for perioperative blood transfusion in patients undergoing coronary artery bypass grafting (CABG).MethodsPubMed, Web of Science, The Cochrane Library, EMbase, CNKI, WanFang and VIP Database were electronically searched to collect case-control and cohort studies about the risk factors for perioperative blood transfusion in patients undergoing CABG from inception to February 2020. Two reviewers screened and evaluated the literatures according to the inclusion and exclusion criteria, and meta-analysis was performed by using RevMan 5.3 software.ResultsA total of 26 articles were collected, involving 84 661 patients. The results of meta-analysis showed that age (OR=1.06, 95%CI 1.03 to 1.08, P<0.001), age≥70 years (OR=2.14, 95%CI 1.77 to 2.59, P<0.001), female (OR=1.85, 95%CI 1.55 to 2.22, P<0.001), body mass index (OR=0.94, 95%CI 0.90 to 0.98, P=0.003), weight (OR=0.95, 95%CI 0.93 to 0.96, P<0.001), body surface area (OR=0.19, 95%CI 0.10 to 0.39, P<0.001), smoking (OR=0.80, 95%CI 0.69 to 0.93, P=0.003), diabetes (OR=1.15, 95%CI 1.09 to 1.20, P<0.000 01), chronic heart failure (OR=1.59, 95%CI 1.26 to 1.99, P<0.001), number of diseased coronary arteries (OR=1.17, 95%CI 1.01 to 1.35, P=0.030), reoperation (OR=2.12, 95%CI 1.79 to 2.51, P<0.001), preoperative hemoglobin level (OR=0.60, 95%CI 0.43 to 0.84, P=0.003), preoperative ejection fraction <35% (OR=2.57, 95%CI 1.24 to 5.34, P=0.010), emergency surgery (OR=4.09, 95%CI 2.52 to 6.63, P<0.001), urgent operation (OR=2.28, 95%CI 1.25 to 4.17, P=0.007), intra-aortic balloon pump (OR=3.86, 95%CI 3.35 to 4.44, P<0.001), cardiopulmonary bypass (OR=4.24, 95%CI 2.95 to 6.10, P<0.001), cardiopulmonary bypass time (OR=1.01, 95%CI 1.01 to 1.01, P<0.000 01) and minimum hemoglobin during cardiopulmonary bypass (OR=0.42, 95%CI 0.23 to 0.77, P=0.005) were the risk factors for perioperative blood transfusion in patients undergoing CABG.ConclusionCurrent evidence shows that age, age≥70 years, female, body mass index, weight, body surface area, smoking, diabetes, chronic heart failure, number of diseased coronary arteries, reoperation, preoperative hemoglobin level, preoperative ejection fraction<35%, emergency surgery, urgent operation, intra-aortic balloon pump, cardiopulmonary bypass, cardiopulmonary bypass time and minimum hemoglobin during cardiopulmonary bypass are risk factors for perioperative blood transfusion in patients who undergo CABG. Medical staff should formulate and improve the relevant perioperative blood management measures according to the above risk factors, in order to reduce the perioperative blood utilization rate and improve the clinical prognosis of patients.
This paper is aimed to assess the effects of red blood cell (RBC) transfusion on clinical outcomes in cardiac surgery. Trials were identified by computer searches of the Pubmed,MEDLINE,Cochrane Library (Issue10,2012),from January 1980 to October 2012. References in identified trials and review articles were checked and experts contacted to identify any additional trials. The homogeneous randomized controlled trials (RCTs) were analyzed with RevMan 5.1 software. Five trials involving a total of 1,203 patients were identified. The results of meta-analyses showed that restrictive transfusion strategies reduced the risk of receiving a RBC transfusion (MD=-1.46,95% CI -1.18--1.1) and the volume of RBCs transfusion (RR=0.69,95% CI 0.53-0.89). No significant difference was noted between the two strategies in terms of mortality,adverse events and hospital or intensive care length of stay. Based on the results mentioned above, one can draw a conclusion that restrictive transfusion strategies reduced the risk of receiving RBC transfusion and the volume of RBCs transfused. Restrictive transfusion strategies did not appear to impact on the rate of adverse events and hospital or intensive care length of stay, compared to liberal transfusion strategies.
Objective To investigate the risk factors of perioperative red blood cells transfusion for coronary artery bypass grafting (CABG) surgery. Method We retrospectively analyzed the clinical data of 534 patients underwent CABG in our hospital from January to March 2014 year. Those patients were divided into two groups:an on-pump coronary artery bypass grafting group (on-pump group) and an off-pump coronary artery bypass grafting group (off-pump group). There were 185 males and 54 females with a mean age of 59.1±9.4 years in the on-pump group. There were 233 males and 62 females with a mean age of 60.3±8.5 years in the off-pump group. Preoperative data, the relative parameters of extracorporeal circulation, the quantity of red blood cells transfusion of those two groups were compared. risk factors associated with red blood cells transfusion were evaluated by multivariate logistic regression analysis. Results The risk factors of perioperative red blood cells transfusion were age (OR=1.04, 95% CI 1.02-1.07, P=0.001) , weight (OR=0.95, 95% CI 0.93-0.97, P<0.001) , smoking (OR=0.61, 95% CI 0.39-0.94, P=0.027) , preoperative level of HCT (OR=0.90, 95% CI 0.85-0.96, P=0.001) and cardiopulmonary bypass (CPB) (OR=4.90, 95% CI 3.11-7.71, P<0.001) . During CPB, the nadir hemoglobin (nHb) (OR=0.63, 95% CI 0.47-0.84, P=0.002) was the only independent risk factor of red blood cell transfusion. Conclusions Age, weight, non-smoking, preoperative level of HCT, CPB are the risk factors for patients underwent CABG perioperatively and the lowest level of Hb in CPB is an independent risk factor of perioperative red blood cells transfusion.
ObjectiveTo review the perioperative blood management (PBM) of total knee arthroplasty (TKA) and total hip arthroplasty (THA).MethodsRecent researches on PBM for TKA and THA were comprehensively read and summarized. Then the advantages and disadvantages of various measures together with the clinical experience of West China Hospital of Sichuan University were evaluated from three aspects, including optimizing hematopoiesis, reducing blood loss and blood transfusion, which could provide a basis for clinical selection.ResultsThere are many PBM methods in TKA and THA, among which the optimization of hematopoiesis mainly includes the application of perioperative iron and erythropoietin. Measures to reduce bleeding include the use of tourniquet, intraoperative controlled hypotension, and perioperative antifibrinolytic agents. Autologous blood transfusion includes preoperative autologous blood donation, hemodilution and cell salvage. Allogeneic blood transfusion is the ultimate treatment for anemia. The application of erythropoietin combined with iron therapy for blood mobilization before surgery together with intraoperative controlled hypotension for bleeding control and the multiple use of tranexamic acid can achieve satisfactory clinical results.ConclusionIn the perioperative period of TKA and THA, single or multiple use of different blood management measures should be considered carefully according to the physical and economic conditions of patients individually, so as to reduce the blood loss and allogeneic blood transfusion optimally, and finally accelerate the recovery of patients.
The incidence of cardiovascular disease remains high, and surgery is an important measure for the treatment of cardiovascular disease. However, cardiovascular surgery is complicated and difficult, and it is one of the departments with the highest rate of allogeneic blood transfusion. Allogeneic blood transfusion significantly increases the complications and mortality of patients, while autologous blood transfusion can effectively reduce allogeneic blood transfusion and adverse reactions. Autologous plateletpheresis technology is a popular autotransfusion method in recent years. This article reviews the autologous plateletpheresis technology and its clinical application in cardiovascular surgery.
Objective To explore the clinical application of the postanesthetic autologus donation and the post-operative transfusion during the knee and hipreplacement surgeries. Methods Thirty-three patients (17 males,16 females) admitted for the elective joint replacement surgeries from September 2004 to January 2005 were included in this study. Of the 33 patients, 5 were diagnosed with rheumatoid arthritis, 23 with femoral head necrosis, and 5 with knee osteoarthritis. Immediately after anesthesia, 400 ml of the blood was drawn and transfused after the surgery. The blood pressure was monitored during the blood drawing, postoperative blood parameters were recorded, surgical site drainage and signs of infections were observed, and the other clinical data were collected.Results Of the 33 patients, 27 only received autologoustransfusion, including 21 patients who underwent the unilateral hip replacement and 6 patients who underwent the unilateral knee replacement. All these 6 patients with the unilateral knee replacement received the blood drained from the surgical sites in addition to the blood obtained from the postanesthetic autologous donation. Another 6 cases with the bilateral hip and knee replacement received the blood drained from the surgical sites, the blood obtained from the post-anesthetic autologous donation and 400 ml of the allogeneic blood transfusion. The blood received postoperatively averaged 650 ml (range, 200-1 150 ml), haemoglobin(Hb) was averaged 88 g/L (68-102 g/L), and Hct was averaged 24.6% (20.5% 31.5%). Hb and Hct were lower after operation than before operation(Plt;0.01). Conclusion Postoperative blood transfusion following the postanesthetic and preoperative autologous donation can be successfully applied to most of the patients undergoing theknee or hip replacement so as to reduce complications of the allogeneic blood transfusion.