Clinical application of evaluation of blood loss of operation patients with Hb dynamic change
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摘要: 目的:探讨患者血红蛋白(Hb)的24 h动态法评估手术患者失血量。方法:选择住院的手术患者96例为研究对象,按手术类别分择期手术组(42例)和非择期手术组(54例),比较Hb的24 h动态法失血量和临床常用称重+计量法失血量的差异,同时分析Hb的24 h动态法在2组间的失/输血比、达到预期Hb比率和输血过量或不足率等指标。结果: 择期手术组Hb的24 h动态法失血量和称重+计量法失血量差异无统计学意义(t=1.51,P>0.05),非择期手术组Hb的24 h动态法失血量和称重+计量法失血量差异有统计学意义(t=15.98,P<0.01),择期手术组的失/输血比明显低于非择期手术组(χ2=115.95,P<0.01),输血后达到预期Hb的比率在择期手术组和非择期手术组间差异有统计学意 (χ2=4.92, P<0.05),其中,择期手术组发生过量或不足有2例,而非择期手术组发生11例。结论:Hb的24 h动态法优于称重+计量法,具有精确和简单易行的优点,设定患者术后HB目标值后,效果更佳,为临床医生和输血科提供了一个客观的输血指标,极大地减少了因输血带来的风险,在临床工作中可以选择性的应用,但应注意患者在就诊前的失血量和因机体的代偿变化引起Hb假性增高。
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关键词:
- Hb的24 h动态法 /
- 称重法和计量法 /
- 手术患者 /
- 失血量
Abstract: Objective:To investigate the evaluation of blood loss of operation patients by 24 h dynamic method of patient's Hb. Method:According to the surgical category, 96 operation patients were divided into two groups:the elective surgery group (n=42) and the non-selective surgery group (n=54). The blood loss differences between 24 h dynamic method of Hb and clinical commonly used measurement method with weighing were compared. In the meanwhile, the indexes were analyzed as following:the ratio of blood loss to blood transfusion of 24 h dynamic method of Hb, the proportion achieved expected Hb, the proportion of overloaded blood transfusion, the proportion of insufficient blood transfusion and so on.Result:There was no statistical difference between the blood loss of 24 h dynamic method of Hb and measurement method with weighing in the elective surgery group(t=1.51,P>0.05), but statistical differences occurred between the blood loss of the 24 h dynamic method of Hb and the measurement method with weighing in the non-selective surgery group(t=15.98,P<0.01). Furthermore, the ratio of blood loss to blood transfusion in the elective surgery group was remarkable lower than that in the non-selective surgery group(χ2=115.95,P<0.01), and statistical differences showed up on the proportion achieved expected Hb after blood transfusion between the elective surgery group and the non-selective surgery group (χ2=4.92, P<0.05), in which the elective surgery group with excessive or deficient occurred in 2 cases, while the elective surgery group occurred in 11 cases. Conclusion:Because of the advantages of accuracy and simple feasibility, the 24 h dynamic method of Hb was superior to the measurement method with weighing. Moreover, it was much better when the target Hb value of postoperative patients was set, which provided an objective blood transfusion index for clinician and blood transfusion department, and greatly reduced the risk induced by blood transfusion, but the pseudo increased Hb which was caused by blood transfusion and compensation of the body before hospital visiting should be paid attention to. -
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[1] 周佳,许汪斌.创伤及围手术期患者失血量的评估方法[J].临床合理用药,2011,4(11B),159-160.
[2] 张新华,雷鹏琼,陈长香.术中失血量对手术患者记忆障碍的影响及护理对策[J].护理学杂,2012,27(6):45-47.
[3] 高玉镭,王东辰,李佩佳.人工全髋关节置换术隐性失血量的估算及原因分析[J].实用医药杂志,2012,29(6):490-492.
[4] Naveen Eipe, Manickam Ponniah. Perioperative Blood Loss Assessment-How Accurate[J].Indian J ANaesth, 2006, 50:35-38.
[5] 陈静刚,镇万源.老年粗隆间骨折围手术期隐性失血分析[J].昆明医学院学报,2012,33(4):125-127.
[6] 卢燕雯.输血科核查制度与检验新规范及主任工作必备手册[M].北京:人民卫生出版社,2010:204-207.
[7] 冉启蓉,阳世光,陈武玉.术中血红蛋白输血指征临床研究[J].齐鲁护理杂志,2011,17(17):13-14.
[8] 胡斌,赖俊浩.限制输血量对肝硬化上消化道出血患者再出血的影响[J].临床医学,2010,30(6):110-111.
[9] 刘素芳,王雅丽.外科手术中大量快速输血并发症原因分析及护理现状[J].齐鲁护理杂志,2013,19(2):52-54.
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