Experimental study on infusion effect and blood quality after warming and pressurizing transfusion
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摘要: 目的:研究在不同压力和温度下快速输注去白细胞全血对红细胞溶血率、形态以及血清钾等指标的影响,筛选安全快速输血的适宜施压强度和加温温度,为研制加温加压输血装置提供数据支撑。方法:将加压、加温装置自上而下依次安装在输液架上,开启电源,设定加压参数分别为0 kPa、5 kPa、10 kPa、15 kPa、20 kPa和25 kPa,将输血器管路嵌入加温管内,通过调节温控器设置输血管路加温温度,取400 mL保存10 d的去白全血,连接输血器和收集袋,进行模拟加温加压输血,记录血液流速的变化,检测收集袋内的血液在不同施压情况下流经40℃、45℃、50℃、55℃加温管后的升温效果和处理前后红细胞形态、游离血红蛋白浓度和血钾指标的改变,评价加温加压后的输注效果以及对血液质量的影响。结果:加压可明显提高输血速度,血液流速与温度和施压强度呈正相关。在温度<55℃、压力<20 kPa情况下,血浆游离血红蛋白测定值为0.075~0.184g/L,红细胞溶血率为0.035%~0.093%,血清钾浓度为7.44~9.75mmol/L,检测结果与加温加压输注前比较差异均无统计学意义(P>0.05)。当温度和(或)压力高于以上数值时,高倍镜下可见少量变形红细胞和细胞碎片。结论:在温度<55℃、压力<20 kPa的情况下加温加压输血,短时间内不会引起有意义的红细胞溶血,血浆游离血红蛋白及红细胞溶血率无明显变化,血液质量完全符合《医疗机构临床用血管理办法》2012版的标准要求。Abstract: Objective: To study the effect of rapid infusion of leukocyte-depleted whole blood on the change of RBC morphologic, hemolysis rate and blood potassium during the different temperature and compression, in order to provide some data support for the development of rewarmed and pressurized transfusion devices.Methods: First of all installed the pressurizing and rewarming devices on the infusion stand, turned on the power to set the repressurized parameters to 0 kPa, 5 kPa, 10 kPa, 15 kPa, 20 kPa and 25 kPa. Inserted the blood transfusion line into the rewarming tube of the heating instrument, then the 400 mL blood stored for 10 days were selected to set up the thermostat by adjusting the thermostat to set the heating temperature, performed a simulated rewarmed and pressurized infusion test to detect the red blood cell morphology, the shape and the blood transfusion effect after the blood flowed through the 40℃, 45℃, 50℃ and 55℃ heating tube under different pressure conditions. The changes in free hemoglobin concentration, serum potassium and blood flow rate were detected. The effect of infusion on blood quality and flow rate under different temperature and pressure conditions compared with untreated was valuated.Results: The blood flow rate was positively correlated with the temperature and pressure intensity. Under the temperature 55℃ and the pressure 20 kPa for rewarming and pressurizing blood transfusion, the measured value of plasma free hemoglobin varied from 0.075 to 0.184 g/L, the red blood cells hemolysis rate fluctuated at 0.035% to 0.093% and the blood potassium concentration fluctuated from 7.44 to 9.75 mmol/L. The three test results were no significant difference before infusion(P>0.05). With the increase of external temperature and pressure, a small amount of deformed red blood cells and its debris could be seen under the high magnification.Conclusion: The blood after rewarmed and pressurized would not cause significant erythrocyte hemolysis in a short time under the temperature below 55℃ and pressure less than 20 kPa. The blood free hemoglobin and erythrocyte hemolysis rate have no significant changed. The quality of blood is completely up to the standard requirements of the 2012 edition of the Management regulations of Clinical Blood Transfusion in Medical Institutions.
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