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Effectiveness of Intraoperative Autotransfusion in Mild-bleeding Surgery: a Randomized Controlled Trial
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摘要:
目的 探讨术中回收式自体输血(intraoperative autotransfusion, IAT)能否改善少量出血患者的组织氧合及术后恢复。 方法 选择2011年12月至2012年4月在北京协和医院行腰椎后路手术、美国麻醉医师协会(American Society of Anesthesiologists, ASA)分级为Ⅰ~Ⅱ级且预计出血量 < 20%血容量的患者, 随机分为两组, 回输组输注回收自体血, 对照组给予等量胶体液。检测两组患者术前、术中及术后血红蛋白(hemoglobin, Hb)、乳酸及脑氧饱和度, 随访并比较术后恢复指标, 包括体温、不适主诉、切口愈合、下地行走时间及术后住院时间。 结果 共38例患者纳入本研究, 回输组和对照组各19例。回输组术后0.5 h和术后1 d的Hb均高于术中水平[分别为(116.5±10.7)、(115.4±12.3)、(106.6±12.6)g/L; P=0.001, P=0.004], 而对照组术后Hb与术中比较差异无统计学意义(P > 0.05)。对照组术后0.5 h乳酸高于术前[(2.5±1.0)mmol/L比(1.3±0.6)mmol/L, P=0.016], 而回输组术后乳酸与术前比较差异无统计学意义(P > 0.05)。术后Hb、乳酸及脑氧饱和度两组间差异均无统计学意义(P > 0.05)。两组术后恢复指标差异亦均无统计学意义(P > 0.05)。 结论 在健康成人患者少量出血手术中使用IAT, 对术后早期组织氧合有一定改善作用, 但对术后恢复无显著影响。 Abstract:Objective To investigate the effectiveness of intraoperative autotransfusion (IAT) in improving tissue oxygenation and postoperative recovery in patients undergoing mild-bleeding surgery. Methods We selected patients scheduled for posterior lumbar surgery at Peking Union Medical College Hospital from December 2011 to April 2012, at American Soceity of Anesthesiologists grade Ⅰ-Ⅱ, and with estimated blood loss less than 20% of their blood volume. The patients were randomly divided into the IAT group (given salvaged autologous blood) and the control group (given equal volume of colloid solution instead). Hemoglobin (Hb) level, lactate level, and cerebral oxygen saturation before, during, and after the surgery were compared between the two groups. Postoperative recovery indexes of the 2 groups were compared, including body temperature, chief complaint, wound healing, ambulation time, and postoperative length of stay. Results Thirty-eight patients were enrolledand randomly divided into the IAT group (n=19) and the control group (n=19). In the IAT group, postoperative half-hour and postoperative 1-day Hb levels were (116.5±10.7)g/L and (115.4±12.3)g/L, respectively, both significantly higher than the intraoperative level[(106.6±12.6)g/L; P=0.001, P=0.004]; while no such significant differences were found in the control group (P > 0.05). Lactate level was significantly elevated at postoperative half-hour compared with preoperative level in the control group[(2.5±1.0)mmol/L vs. (1.3±0.6)mmol/L, P=0.016], while the trend was absent in the IAT group. There were no significant differences in postoperative Hb level, lactate level, and cerebral oxygen saturation between the two groups (P > 0.05), nor in any of the postoperative recovery indexes (P > 0.05). Conclusion The use of IAT in healthy adult patients undergoing surgery with estimated small blood loss could improve early tissue oxygenation after the surgery, but with no significant influence on postoperative recovery. -
表 1 两组患者一般资料[($\overline x \pm s$)/例]
组别 年龄(岁) 身高(cm) 体重(kg) 性别(男/女) ASA分级(Ⅰ/Ⅱ) 手术节段数* 术前Hb
(g/L)术中主要操作结束后Hb
(g/L)术中出血量
(ml)Cell Saver洗涤后
血量(ml)术后引流量
(ml)对照组(n=19) 55.8±11.8 162±9 67.9±12.2 8/11 8/11 1(2) 145.0±11.9 115.0±17.0 363±147 143±45 259±132 回输组(n=19) 55.4±14.0 161±8 68.4±8.4 3/16 7/12 2(5) 138.6±9.5 106.6±12.6 335±147 163±70 277±151 P值 0.911 0.588 0.878 0.151 1.000 0.096 0.077 0.091 0.553 0.307 0.703 ASA：美国麻醉医师协会；Hb：血红蛋白；*不符合正态分布，以中位数(全距)表示，采用Mann-Whitney U检验 
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表 2 两组患者术前、术中及术后的血红蛋白变化($\overline x \pm s$, g/L)
组别 血红蛋白 T0 T1 T2 T3 T4 对照组(n=19) 测量值 145.0±11.9* 115.0±17.0 118.1±15.8 118.8±15.3 116.1±15.4 P值 0.000 0.557 0.659 1.000 回输组(n=19) 测量值 138.6±9.5* 106.6±12.6 116.5±10.7* 115.4±12.3* 109.4±13.0 P值 0.000 0.001 0.004 1.000 T0：手术诱导前；T1：术中主要操作结束后；T2：术后0.5 h；T3：术后1 d；T4：术后3 d; 与同组T1数值比较，*P < 0.05
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表 3 两组患者术前、术中及术后的乳酸变化($\overline x \pm s$, mmol/L)
组别 乳酸 T0 T1 T2 T3 T4 对照组(n=19) 测量值 1.3±0.6 1.5±0.7 2.5±1.0* 1.3±0.6 1.0±0.3 P值 1.000 0.016 1.000 0.356 回输组(n=19) 测量值 1.2±0.5 1.9±1.1 2.1±1.2 1.5±0.8 1.0±0.5 P值 0.337 0.114 1.000 1.000 T0、T1、T2、T3、T4：同表 2；与同组T0数值比较，*P < 0.05
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表 4 两组患者术前及术后的CsO2变化($\overline x \pm s$, %)
组别 CsO2 T0 T2 T3 T4 对照组(n=19) 测量值 76.3±3.9 71.1±4.4* 72.9±4.4 71.5±4.0* P值 0.000 0.121 0.001 回输组(n=19) 测量值 76.0±3.6 71.4±4.5* 74.6±3.8 72.4±4.0* P值 0.001 1.000 0.033 T0、T2、T3、T4：同表 2；CsO2：脑氧饱和度；与同组T0数值比较，*P < 0.05
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表 5 两组患者术后恢复情况
组别 术后开始
下地行走
时间(d)术后住院
时间(d)头晕、乏力
或心悸
(有/无)术后发热
(≥38 ℃/
< 38 ℃)对照组(n=18) 3.1±0.7 7.2±3.5 2/17 5/14 回输组(n=19) 3.0±0.7 7.2±2.0 4/15 9/10 P值 0.647 0.945 0.631 0.179
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