叶惠艳 游敏吉 孙敏

[摘要] 目的 探讨体外循环下瓣膜置换术自体血回输护理技术的临床应用效果。 方法 以2016年1月～2017年12月接受自体血回输的体外循环下心脏瓣膜手术病例50例为研究样本，以随机数字表法分为等量（25例）常规护理组与精细化护理组，对两组接受自体血回输的体外循环下心脏瓣膜手术病例干预后在输血不良反应发生比例与手术医师护理满意率两个观察指标的差异度加以比较分析。 结果 术后精细化护理组患者的Cys C（0.89±0.18）mg/L与CRP水平（2.23±0.47）mg/L明显低于常规护理组患者，差异有统计学意义（P<0.01）。精细化护理组输血不良反应率4.00%，显著低于常规护理组的28.00%，两组比较差异具有统计学意义（P<0.05），手术医师对精细化护理组自体血回输护理满意率100.00%，显著高于常规护理组的76.00%，两组比较差异具有统计学意义（P<0.05）。 结论 精细化护理在体外循环下瓣膜置换术自体血回输护理实践中具备显著降低输血反应风险与提高手术医师护理配合满意率的积极价值。

[关键词] 自体血回输；体外循环下瓣膜置换术；输血反应；护理

[中图分类号] R471.3 [文献标识码] B [文章编号] 1673-9701（2018）28-0148-04

[Abstract] Objective To investigate the clinical effect of autologous blood transfusion in the valve replacement surgery under cardiopulmonary bypass. Methods 50 cases of heart valve surgery under cardiopulmonary bypass receiving autologous blood transfusion from January 2016 to December 2017 were selected as study samples， and were divided into routine care group （n=25） and fine care group （n=25） by random number table method. The differences in indicators of adverse reactions in blood transfusion and the satisfaction rate of surgeons care between the two groups after intervention of heart valve surgery and autologous blood transfusion were compared and analyzed. Results The Cys C（0.89±0.18） mg/L and CRP （2.23±0.47）mg/L was significantly lower in patients in the fine care group than that in the regular care group， and the difference was statistically significant（P<0.01）. The rate of adverse reactions of blood transfusion in the fine care group （4.00%） was significantly lower than that of the regular care group （28.00%）. There was a statistically significant difference between the two groups（P<0.05）. The surgeon's satisfaction rate of the care of the autologous blood in the fine care group（100.00%） was significantly higher than that in the conventional care group at 76.00%， and there was a statistically significant difference between the two groups（P<0.05）. Conclusion The fine nursing has the positive value of significantly reducing the risk of transfusion reaction and improving the surgeon's satisfaction with nursing care in the practice of autologous blood transfusion for valve replacement under cardiopulmonary bypass.

[Key words] Autologous blood transfusion； Valve replacement under cardiopulmonary bypass； Transfusion reaction； Nursing

心臟瓣膜手术护理对象在术前多处于贫血合并状态，贫血原因主要来自于漫长病程、心功能不佳及长期存在的营养不良等，贫血状态再加上术中的长时间转流、血液成份的大幅度破坏等因素，该类护理对象术后创面会出现较大量渗血，故需大量补充血液制品，但大量输入库血常致一系列不良反应而严重威胁心脏瓣膜手术护理对象之安全，自体血回输技术的应用，一方面可较大程度上成功规避异体血输注的诸多不良反应风险，另一方面亦可有效解决血源紧张难题，特别是对于稀有血型手术者意义重大[1-2]。心脏瓣膜手术自体血回输技术能否获得成功实施，与高效优质的护理配合存在不可分割的内在联系，我院以2016年1月～2017年12月接受自体血回输的体外循环下心脏瓣膜手术病例50例为研究样本，探讨常规自体血回输护理与精细化自体血回输护理的应用效果差异性，现报道如下。……