RU1776416C - Intraoperation method for exfusion of autoblood in surgery - Google Patents

Abstract

Usage: medicine, anesthesiologists, resuscitators for intraoperative exfusion of eutent blood during surgical interventions. The essence of the method: during the surgical operation, autoblood is withdrawn and blood substitutes are introduced, the first stage of exfusion is carried out prior to induction anesthesia in the amount of 400 ml of autologous blood, blood loss is replaced by blood substitutes and crystalloids, the second stage is additionally exfused with 200 -800 ml of autologous blood, without tolerance reduction in the level of venous hematocrit below 0.5-0.20 g / l. The method allows to reduce the volume of exfusion upon reaching maximum hemodilgia and to carry out exfusion in patients with blood loss and anemia.

Description

The invention relates to medicine, namely to anesthesiology and resuscitation, and can be used in surgery for traumatic surgical operations.

Known methods of reducing the volume of blood loss and blood substitution, based on the use of intraoperative reserving of the patient’s autologous blood and hemodilution (Zhuravlev, Svedents, Sukhorukov, 1985) The main disadvantages of the methods used by the authors are:

1. Dilution of the patient’s blood with polyglucin solutions and crystalloids, which reduces the effect of red blood cell and plasma reservation

2. An insufficient level of hemodilution realization (only up to 0 34 l / l), which leads to blood loss with high levels of red blood cells and plasma

3. The complexity of the method, requiring the participation of a transfusiologist and two nurses, which is of little use in emergency surgery.

4. The method used in the implementation of hemodilution uses a large number of saline solutions and 5% glucose that quickly leave the vascular bed and are retained in extracellular spaces.

The aim of the invention is to simplify the method by reducing the volume of exfusion while achieving maximum hemodilution and exfusion in patients with blood loss and anemia.

The essence of the proposed method and its distinguishing features from the prototype is to reduce the volume of operational blood loss due to hypervolemic hemodilution, limiting the loss of red blood cells and plasma is painful VI VI

ABOUT

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potential for reducing the use of donated blood. This is achieved due to intraoperative two-stage blood exfusion in a volume of 600-1200 ml and the implementation of hypervolemic hemodilution with a decrease in venous hematocrit to 0.15-0.25 l / l, which allows blood exfusion in patients with blood loss and anemia.

The goal is achieved by the fact that at the first stage of exfusion, physiologically complete autologous blood of the patient is reserved in a volume of 400 ml. In a second step, blood is stored with a varying degree of hemodilution in a volume of 200 to 800 ml. Two-stage autologous blood sampling in combination with hypervolemic hemodilution due to the use of protein-free plasma expanders (polyglycine, gelatinol), 10% glucose solution and the organic use of isotonic crystalloids in a volume of up to 500 ml can achieve a reduction in the volume of operational blood loss due to a decrease in hematocrit to 0.15 -0.25 l / l.

The method is carried out as follows.

After traditional preparation of the patient for surgery on the operating table, venous blood hematocrit, hemoglobin and erythrocyte counts in peripheral blood are determined before anesthesia begins. Based on the obtained values, the volume of blood exfusion and hypovolemia-correcting volumes of colloidal solutions, 10% glucose and crystalloid solutions providing the effect of hypervolemic hemodilution during surgery are calculated.

In the absence of anemia in the patient (hemoglobin - 110-120 g / l, hematocrit 0.37-0.47 l / l), the permissible volume of blood exfusion is 1000-1200 ml, which requires the implementation of hypervolemic hemodilution using polyglu solutions kin, reopoliglyukin, gelatinol, a solution of glucose and sodium chloride, their use in a total double volume of the volume of exfused blood.

In cases of moderate anemia (hemoglobin 90-100 g / l, hematocrit 0.30-0.35 l / l), the volume of autoblood withdrawal is limited to 800-1000 ml.

When pronounced anemia is established in a patient (hemoglobin 50-85 g / l, hematocrit 0.25-0.35 l / l), the volume of autologous blood intake is limited to 600-800 ml with the subsequent realization of the effect of hypervolemic hemodilution with a total double volume of these solutions. AT

similar cases during the operation transfused donor blood.

The autologous blood sampling process is carried out in stages: first, 400 ml autologous blood is taken at once simultaneously into standard containers with 50 ml of glugicir. After that, 400 ml of polyglucin is infused intravenously at a rate of 50-100 ml / min. Control hemodynamic status

0 and induction of anesthesia is carried out, for example, with 1% sodium thiopental solution in a dose that turns off consciousness (250-300 mg). The trachea is then intubated after administration of the muscle relaxant. for example, myo-re15 laxine (100-150 mg) and basic anesthesia is performed under mechanical ventilation, for example, nitrous oxide with oxygen in a ratio of 2: 1 and NLA preparations. At this stage of the operating period, continue

0 dropwise intravenous administration of a 0.9% 500 ml sodium chloride solution at a rate of 100-120 drops / min. They control the level of blood pressure, CVP, heart rate and proceed to the second stage, taking the estimated volume

5 autologous blood of the patient. The second stage of blood sampling can be carried out against the background of surgery, but under conditions of stable hemodynamics. It ranges from 200 to 800 ml depending

0 from baseline hemoglobin and hematocrit. 400 ml of polyglucin, 450 ml of gelatinol, 500 ml of a solution of 10% glucose are replaced with exfused blood, exceeding the infusion volume over the ex5 infusion volume by 500 ml. After taking the calculated amount of blood, the venous hematocrit is monitored. Usually a decrease of 0.12-0.19 l / l is noted.

After monitoring venous parameters

0 hematocrit, if necessary, additional hypervolemic hemodeduction is carried out with a 10% glucose solution (1000 - 2500 ml) at a speed of 100-120 drops / min. under the control of diuresis, which should be at least 50-100 ml / hour. When the required level of hemodilution (hematocrit 0.15-0.25 l / l) is reached, the infusion rate of hemodiluteants (reopoliglyukin and 10% glucose solution) is such that the blood pressure is kept within physiological limits with an adequate depth of general anesthesia. Surgical blood loss is replaced by a double volume of hemodilute. The total volume of infusion therapy during surgery should be twice the volume of exfusion and surgical blood loss.

Autohemotransfusion is performed after surgical hemostasis is achieved in the wound at the end of the operation. Autohemotransfusion rates are measured against blood pressure.

CVP and pulse, tolerance increase in CVP to 25-35 cm of water.

Example 1. Sick Ea OV, 39 years old. East. bol, No. 2945. Dz: fibroids of the uterus with the isthmus-cervical node. Surgery: laparotomy, supravaginal amputation of the uterine body without appendages.

The patient was delivered to the operating room with indicators: erythrocytes - 4.3-10 / l, hemoglobin - 155 g / l, blood pressure - 140/90 mm Hg. Art., pulse - 98 beats / min., CVP - 3 cm water column, venous hematocrit - 0.47 l / l. Body weight - 90 kg, height - 163 cm, estimated bcc - 5850 ml.

Stage of blood exfusion - 400 ml before induction of anesthesia. After taking autologous blood pressure - 130/90 mm RT. Art., pulse - 108 bpm, satisfactory filling, rhythmic. Substitution of taken blood: polyglucin - 400 ml, sodium chloride solution 0.9% - 500 ml. HELL - 135/90 mm RT. Art., pulse - 108 beats / min. Induction anesthesia with 1% sodium thiopental solution - 300 mg. The main anesthesia is endotracheal nitrous oxide with oxygen (2: 1) and NLA drugs under mechanical ventilation.

II stage of exfueia of blood. Taking into account the patient’s body weight and high hemoglobin and venous hematocrit, 1000 ml of autologous blood was exfused against the background of stable hemodynamics. Substitution of exfused blood: polyglucin - 800 ml, gelatin - 200 ml. After replacing the taken blood with one volume, the hematocrit decreased to 0.31 l / l. HELL - 140/80 mm RT. Art., pulse - 108 beats / min. Since the required level of hemodilution is not achieved, a 10% glucose solution of 1000 ml is infused at a speed of 100-120 drops / min. After replacing the exfused blood with a second volume, the venous hematocrit decreased to 0.24 L / L.

The operation was complicated by blood loss - 2400 ml. Blood loss compensation: gelatin - 700 ml, 10% glucose solution - 1400 ml. After surgical hemostasis was achieved, autologous blood of 1400 ml was collected and 1350 ml of blood collected from the surgical floor.

In total, 5150 ml of colloids and crystalloids were transfused during the operation, which made it possible to correct hypovolemia and reduce hematocrit to 0.15 l / l. After autohemotransfusion and blood reinfusion, venous hematocrit - 0.34 l / l, CVP - 13 cm water column, blood pressure - 130/90 mm Hg. Art. A day after the operation: red blood cells 3.8-10 12 / l, hemoglobin 125 g / l, venous hematocrit 0.35 l / l. Postoperative course without complications. No blood transfusion was required.

Example 2. Sick Va S.P. 47 years old, East, Bol. No. 9812. D-s: uterine endometriosis in

combination with uterine fibroids. Secondary posthemorrhagic anemia. Operation: gluttony, extirpation of the uterus without appendages. The patient was delivered to the operating room with the following indicators: hemoglobin 50 g / l, erythrocytes - 1.7-10 12 / l, blood pressure - 180 / 12.0 mm Hg. Art. (at rest HELL - 130/80 mm Hg, st.), pulse - 120 beats / min., venous hematocrit 0.24 l / l, CVP - 10 cm water column. Body weight - 85 kg, height 165 cm. Estimated bcc - 5525 ml.

Blood transfusion was deliberately not performed prior to the operation. Stressful

hypertension syndrome (blood pressure 180/120 mm

Hg. Art., pulse 120 beats / min.), blood exfusion

decided to be carried out after anesthesia. Introductory anesthesia: thiopental sodium 1% solution - 300 mg. HELL decreased to 120/80 mm RT. Art., pulse - 100 beats / min. Basic anesthesia: intubation with nitrous oxide with oxygen (2: 1) and NLA preparations.

600 ml of blood was simultaneously exfused with simultaneous compensation with polyglucin 800 ml and 0.9% sodium chloride solution 500 ml. HELL 110/70 mm RT. Art., pulse - 70 beats / min. Venous hematocrit decreased to 0.14 L / L. Taking into account the possible adverse effects of operational blood loss, at the stages of the operating period, the following were transfused: erythrocyte mass - 200 ml and donor blood - 750 ml. Venous hematocrit increased to 0.25 L / L. Surgical blood loss with diluted blood - 350 ml. At the end of the operation returned

600 ml autologous blood. The method allowed to limit the volume of transfused donated blood. In the postoperative period, no additional blood transfusion was required. Recovery. At discharge: hemoglobin - 100 g / l, red blood cells - 3.9-10 12 / l.

Claims (1)

SUMMARY OF THE INVENTION A method for intraoperative autologous blood exfusion during surgical interventions, comprising phased autologous blood sampling and administration of blood substitutes, characterized in that, in order to simplify the method by reducing exfusion volumes while maximizing hemodilution and exfusion in patients with blood loss and anemia, the first stage is , fusions are performed prior to induction of anesthesia in an amount of 400 ml of autologous blood, replacing blood loss with blood substitutes and crystalloid, the second stage during the opera During the intervention, a dose of lowering the level of venous hematogenesis is exacerbated by 200-800 ml of autologous blood, not allowed below 0.5-0.20 g / l.