本文選題：冠狀動(dòng)脈旁路移植術(shù) + 冠心病��； 參考：《安徽醫(yī)科大學(xué)》2017年碩士論文

【摘要】：目的目前多種血液保護(hù)措施已應(yīng)用于臨床,回收式自體輸血在非體外循環(huán)下冠狀動(dòng)脈旁路移植術(shù)中有較高的使用價(jià)值。單純回輸洗滌式自體血可能會(huì)引起患者凝血功能障礙及影響內(nèi)環(huán)境穩(wěn)定,造成術(shù)后滲血增多,本研究探討圍手術(shù)期單純回輸洗滌式自體血在不停跳冠狀動(dòng)脈搭橋術(shù)中應(yīng)用的臨床效果。方法回顧性分析2015年8月至2016年7月就診于我科單一手術(shù)醫(yī)指連續(xù)132例行不停跳冠狀動(dòng)脈搭橋術(shù)的患者,根據(jù)患者圍手術(shù)期是否輸入異體血分為實(shí)驗(yàn)組(無異體輸血組)和對(duì)照組(異體輸血組)。對(duì)比分析兩組患者圍手術(shù)期輸異體血量、自體血回輸量、吻合橋血管數(shù)量、術(shù)后24小時(shí)心包縱隔引流量、圍手術(shù)期呼吸機(jī)輔助通氣時(shí)間、主動(dòng)脈球囊反搏(IABP)使用情況、術(shù)后住院天數(shù)及住院費(fèi)用。對(duì)比兩組患者術(shù)前及術(shù)后24小時(shí)血紅蛋白(HGB)、血小板(PLT)、總膽紅素(TBIL)、谷丙轉(zhuǎn)氨酶(ALT)、肌酐(CRE)、凝血酶原時(shí)間(PT)變化情況。觀察患者輸血2h內(nèi)有無體溫升高、皮膚瘙癢或蕁麻疹等輸血反應(yīng)現(xiàn)象張生。結(jié)果實(shí)驗(yàn)組與對(duì)照組患者年齡、體重、性別構(gòu)成、陳舊性心肌梗死病史、左室射血分?jǐn)?shù)及Gesini評(píng)分等指標(biāo)組間均衡性無顯著性差異(P0.05),組間有可比性。圍手術(shù)期呼吸機(jī)輔助通氣時(shí)間實(shí)驗(yàn)組19.44±4.60h,對(duì)照組23.74±8.42h,P0.001,實(shí)驗(yàn)組患者圍手術(shù)期呼吸機(jī)輔助通氣時(shí)間較對(duì)照組短。住院費(fèi)用實(shí)驗(yàn)組11.12±0.17萬元,對(duì)照組12.22±0.27萬元,P0.05,實(shí)驗(yàn)組患者圍手術(shù)期住院費(fèi)用較對(duì)照組低。對(duì)照組患者有3例輸血后出現(xiàn)輸血反應(yīng),實(shí)驗(yàn)組患者未見明顯輸血反應(yīng)(P0.05)。余指標(biāo)組間差異無統(tǒng)計(jì)學(xué)意義(P0.05)。結(jié)論單純回輸洗滌式自體血在不停跳冠狀動(dòng)脈搭橋術(shù)中的應(yīng)用可糾正圍手術(shù)期貧血,減少異體輸血量,對(duì)節(jié)省異體血源應(yīng)用有重要意義,對(duì)患者的凝血功能和術(shù)后恢復(fù)無明顯不良影響,且能夠降低住院費(fèi)用,避免輸血相關(guān)的并張癥,可應(yīng)用于臨床。
[Abstract]:Objective at present, many kinds of blood protection measures have been applied in clinic, and the recovery autotransfusion has high value in off-pump coronary artery bypass grafting. The simple transfusion of washed autologous blood may cause coagulation dysfunction and influence the stability of the internal environment, resulting in the increase of blood leakage after operation. The purpose of this study was to investigate the clinical effect of pure washing autologous blood transfusion during perioperative period in coronary artery bypass grafting. Methods from August 2015 to July 2016, 132 consecutive patients underwent coronary artery bypass grafting were analyzed retrospectively. The patients were divided into experimental group (no allotransfusion group) and control group (allogeneic transfusion group) according to whether the patient received allogeneic blood during perioperative period. The volume of allogeneic blood transfusion, the volume of autologous blood transfusion, the number of anastomosed blood vessels, the pericardium and mediastinal drainage at 24 hours after operation, the time of ventilator assisted ventilation in perioperative period, and the use of IABPin in aortic balloon counterpulsation were compared and analyzed between the two groups. Postoperative hospitalization days and hospital expenses. The changes of HGB, PLT, TBILL, alt, creatinine (creatinine) and prothrombin time (PTT) were compared between the two groups before and 24 hours after operation. The blood transfusion reaction such as skin pruritus or urticaria were observed. Results there was no significant difference in age, body weight, sex composition, history of old myocardial infarction, left ventricular ejection fraction and Gesini score between the two groups (P 0.05). The time of ventilator assisted ventilation was 19.44 鹵4.60 h in the experimental group and 23.74 鹵8.42 h in the control group (P 0.001). The time of ventilator assisted ventilation in the experimental group was shorter than that in the control group. The cost of hospitalization was 11.12 鹵1700 yuan in the experimental group and 12.22 鹵2700 yuan in the control group (P 0.05). The cost of hospitalization in the experimental group was lower than that in the control group. In the control group, 3 cases had blood transfusion reaction after blood transfusion, but no significant blood transfusion reaction was found in the experimental group (P 0.05). There was no significant difference in other indexes between groups (P 0.05). Conclusion the application of pure washing autologous blood transfusion in beating coronary artery bypass grafting can correct the perioperative anemia, reduce the amount of allogeneic blood transfusion, and have important significance in saving allogeneic blood supply. It has no obvious adverse effect on coagulation function and postoperative recovery of patients, and can reduce hospitalization cost and avoid blood transfusion related syndesmosis. It can be used in clinical practice.
【學(xué)位授予單位】：安徽醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R654.2

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