Suction-induced hemolysis at various vacuum pressures: Implications for intraoperative blood salvage
Suction-induced hemolysis at various vacuum pressures: Implications for intraoperative blood salvage
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DOI：
10.1046/j.1537-2995.1996.36196190516.x
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发表时间：
1996-01-01
期刊：
影响因子：
2.9
通讯作者：
Gregoretti, S
中科院分区：
文献类型：
--
作者：
Gregoretti, S
背景：在术中血液回收过程中，建议抽吸真空压力（VP）不超过150 mmHg，以尽量减少溶血。当该VP提供的吸引因快速出血而变得不足时，应使用替代的高VP吸引并丢弃血液。这种方法往往会导致在抢救只有一小部分的血液脱落在手术过程中并发的大hemorrhage.Study设计和方法：本实验室研究的目的是定量的溶血所造成的各种VP在一个抽吸系统通常用于术中血液抢救。对于每个实验，通过混合过时的红细胞单位，新鲜冷冻血浆和盐水溶液制备一批血细胞比容为30%至35%的血液。在150、200、250和300 μ L的VP下抽吸该血液的等分试样，无（6次实验）或有（4次实验）最大空气夹带。总血红蛋白，红细胞压积，红细胞计数，血浆游离血红蛋白，血清钾在吸前和吸后的每个等分试样进行了测量。结果：吸入血液与空气混合引起更大的溶血比单独吸入血液（p < 0.01，在每个VP测试）。将VP从150升高到300 μ L，当仅抽吸血液时，溶血从0.14 +/-0.20%（平均值+/- SD）增加到0.32 +/-0.21%（p < 0.05），当抽吸血液时，从1.45 +/-0.50%增加到2.85 +/-0.22%（p < 0.05）。与任何一种类型的吸力，红细胞计数，红细胞压积，血清钾没有显着改变整个范围内的VP tested.Conclusion：溶血被发现依赖于VP应用，并在更大程度上，对血液和空气混合的量。将VP增加到推荐限值150 μ L以上与过度溶血无关。即使使用高达300 μ l的VP，溶血率也在0.3%至3.0%之间，这取决于空气是否与血液一起吸入。数据支持这样的观点，即在术中血液回收期间应使用与清晰术野兼容的最低VP，并且应尽可能避免吸入空气。这些数据还表明，与目前的建议相反，如果出血率需要，术中血液回收期间的抽吸VP可增加至300 mmHg，而不会引起过度溶血。
Background: Suction vacuum pressure (VP) not exceeding 150 torr is recommended during intraoperative blood salvage to minimize hemolysis. When the suction provided by this VP becomes inadequate because of brisk bleeding, an alternative high-VP suction should be used and the blood discarded. This approach often results in the salvage of only a small fraction of the blood shed during surgery complicated by large hemorrhage.Study Design and Methods: This laboratory study was designed to quantitate the hemolysis caused by various VPs in a suction system commonly used for intraoperative blood salvage. For each experiment, a batch of blood with a hematocrit of 30 to 35 percent was prepared by mixing of outdated units of red cells, fresh-frozen plasma, and saline solution. Aliquots of this blood were suctioned at VPs of 150, 200, 250, and 300 torr, either without (6 experiments) or with (4 experiments) maximal air entrainment. Total hemoglobin, hematocrit, red cell count, plasma-free hemoglobin, and serum potassium were measured in the blood before suction and in each aliquot after suction.Results: Suction of blood mixed with air caused much greater hemolysis than suction of blood alone (p < 0.01 at each VP tested). Raising the VP from 150 to 300 torr increased hemolysis from 0.14 +/- 0.20 percent (mean +/- SD) to 0.32 +/- 0.21 percent (p < 0.05) when blood alone was aspirated and from 1.45 +/- 0.50 percent to 2.85 +/- 0.22 percent (p < 0.05) when blood was suctioned with air. With either type of suction, red cell count, hematocrit, and serum potassium did not change significantly throughout the range of VPs tested.Conclusion: Hemolysis was found to depend on the VP applied and, to a much greater extent, on the amount of blood and air mixing. Increasing the VP above the recommended limit of 150 torr was not associated with inordinate hemolysis. Even when a VP as high as 300 torr was used, hemolysis ranged between 0.3 and 3.0 percent, depending on whether air was suctioned with the blood or not. The data support the idea that the lowest VP compatible with a clear surgical field should be used during intraoperative blood salvage and that the suctioning of air should be avoided as much as possible. These data also suggest that, in contrast to current recommendations, suction VP during intraoperative blood salvage can be increased up to 300 torr if required by the rate of bleeding, without causing excessive hemolysis.