The Effects Of Autologous Blood Transfusion On Changes Of Coagulation Function In The Ederly

Objective To evaluatethe changes of coagulation function in the ederly patients after reinfusion of autologous scavenged red blood cells and application of Sonoclot coagulation & platelet function analyzer by observation changes of laboratory of coagulation and Sonoclot analyzer examination parameter,such as:APTT(Activated Partial Thromboplastin Time),PT(Prothrombin Time),Hb(Hemoglobin),Hct(Hematocrit),FIB(Fibrinogen),Plt(Platelet count) and SonACT,CR(clot rate),MCS(maximal clot signa),PF(platelet function).Methods Twenty-four ASAⅠ～Ⅱederly patients aged 65～74 years old,undergoing elective spinal operation,whose lost blood volume was more than 600ml.They had no hematologic diseases and were not received an oral medicine for anticoagulant.Their coagulation examnation and other common laboratory examination are normal.Patient with malignant tumor were exclude.Blood salvaged during the operation was not contaminated.Heart Rate(HR),Electrocardiogram(ECG),Arterial Pressure(AP),and Central Venous Pressure(CVP) were monitored continually during the whole operation.The patients undergoing elective spinal operation were randomly divided into two groups.Twelve patients in study group received autologous blood retransfusion,and the other twelve patients in control group received homologous blood transfusion.Anesthesia was induced with fentanyl 3～5μg·kg^-1,etomidate 0.2～0.3 mg·kg^-1and scoline 1～2mg·kg^-1.After tracheal intubation,anesthesia was maintained with fentanyl,propofol, vecuronium and isoflurane.The Haemonetics Cell Saver 5 autotransfusion system was used to salvage the lost blood during operation in the study group.When the blood volume in the strainer achieved 1000ml,the autotransfusion system start to salvage the blood according to the standardization procedure.The velocity of centrifugalization was 5600 rpm/rain.Laboratory of coagulation and Sonoclot analyzer examination were monitored respectively at the time of preoperative,before blood transfusion and after blood transfusion.The measurement data met homoscedasticity present as(?)±s were tested by t-test and variance analysis,otherwise by rank sum test.The threshold for statistical significance was taken as P＜0.05.Results1.General dateThere are no significance difference between two groups on intraoperative blood loss and dose of intraoperative transfusion(include colloid,crystalloidal and blood). 2.changes on Hb and HctThe Hb and Hct of the study group descend to the lowest level before blood transfusion and they step up significantly after blood transfusion.There are no significance difference between two groups on the Hb and Hct.3.changes on laboratory of coagulationThe coagulation function of study group decrease significantly at the time point before blood transfusion compared with that of at point preoperative:Plt,FIB and APTT decrease significantly(P＜0.05);PT,INR prolong significantly(P＜0.01).Plt,FIB continue to decrease after blood transfusion,but APTT and INR are no significant change.The coagulation function of control group also have the similar decrease as the study group at the time point before blood transfusion.In the two groups,similar trends of dynamic change were observed for FIB,Plt,PT and APTT lever during all the times of measurement,but there was no significant difference between the two groups(P＞0.05).4.changes on Sonoclot analyzer examination parameterThe SonACT of both two groups are decrease significantly at the time points before and after blood transfusion compared with that of at the time point preoperative.The CR of the study group are decrease significantly at the time points before and after blood transfusion compared with that of at the time point preoperative too,but the CR of the control group are no significant change.The parameter represented the function of Platelet,PF,TP and MCS of both two groups are no significant change at the time points before and after blood transfusion.There was no significant difference in Sonoclot parameters including clot rate between the two groups(P＞0.05).Conclusion1.This study confirmed that after reinfusion of autologous scavenged red blood cells not only the Hb and Hct are step up significantly,but also the haemodynamics of patients are remained fundamental stabilization.The security of the ederly patients undergoing operation are enhanced obviously.2.Even though the function of coagulation decrease significantly after reinfusion of autologous scavenged red blood cells,but the changes of laboratory of coagulation and Sonoclot analyzer examination parameter are in the approximate extent of normal value and there was no significant difference compared with the control group received homologous blood transfusion.3.This study consider that the ederly patients undergoing operation with normal coagulation examination who received autologous blood retransfusion are safety.The effect to save homologous blood is obviously achieved.This process avoid several adverse effects of the homologous blood transfusion. 4.During the operation,the coagulation function monitoring is very important especially when lots of intraoperative blood loss happened.The blood coagulation factor and Pit should transfusion according to the result of coagulation function examination.5.Sonoclot analyzer is a fine device to provide the instant and continuous coagulation function parameter;to guide the specific scheme of blood transfusion.Sonoclot analyzer is to be worth utilizing generally in major surgery.