Clinical Application And Research Of Autologous Transfusion In The Devascularization Operation Of Portal Hypertension

[Background]Portal hypertension is an increase in the blood pressure within a system of veins called the portal venous system. When the portal vein blood flow is blocked, blood stasis and/or blood flow increase, which usually caused portal hypertension. Portal hypertension often cause of the lower esophageal and gastric varices, and even rupture and hemorrhage, hypersplenism, ascites, hepatopulmonary syndrome, hepatorenal syndrome, which collectively referred to as portal hypertension. Especially the massive hemorrhage caused by rupture of esophageal and gastric varices, which often resulted in the death of a patient. Usually,we use the hepatic venous pressure gradient (HVPG) to represent the portal vein pressure. The HVPG draws from that the measured hepatic venous wedge pressure minus free hepatic venous pressure. When HVPG is higher than6.7cmH2O, which shows the portal pressure is high. Portal hypertension is usually difficult to cure, and we usually inclined to deal with complications of their disease, especially for the treatment of upper gastrointestinal bleeding. For the hemorrhage of upper digestive tract caused by portal hypertension is general larger, higher incidence of hemorrhage again.Each time the bleeding can make the liver function deteriorated further, the high fatality rate. It is one of the difficult clinical treatment. Current,the treatment methods of portal hypertention is many, such as medical, endoscopic, interventional radiology and surgical operation of comprehensive treatment etc. While the surgical operation treatment of portal hypertension is the earliest treatment method,it has a history of60years from its application. The success of liver transplantation marked that the surgery has been fundamentally in the treatment of portal hypertension, but as a result of the shortage of donor and the level of economic limit, at present,the vast majority of patients are unable to receive a liver transplant in our country. Therefore, the traditional devascularization operation in the future, even for a very long period, which remains used usually in the surgical treatment of portal hypertension.Blood transfusion is a special effective treatment measure when rescue urgent, dangerous, serious illness in the clinical. In recent years, although a blood transfusion medical development is rapid, its security has been greatly improved relative to the past, but there is still a danger. About the past blood transfusion method, people reflect and improve it. Find out a method,which not only can meet the needs of the critically ill patient to blood, but make the safety factor of the operation process increased significantly, which is the autologous blood doping in this paper that is discussed. Intraoperative autologous blood doping is a self blood transfusion method.That is the lost blood of patients was collected by using negative pressure attract in the process of operation.The blood was back to the patients after anticoagulation, filtering and other procedures in the perioperative. At present, the blood using in medical grows day by day, the blood source is insufficient, and and it is tremendous waste that intraoperative autologous blood loss. On the other hand, the hepatitis, syphilis, AIDS virus infection and to produce the effect of immune aspects was caused by foreign blood transfusions.which is the great fear for the blood recipients. Therefore, it was attented more and more by people for intraoperative autologous blood recovery, back to lose. Blood conservation is imperative. For patients with portal hypertension, coagulation function is generally poor, splenomegaly, hypersplenism, pancytopenia, esophageal and gastric varices, splenic vein varicose, which make it easy bleeding, oozing, in the devascularization operation. and because the liver reserve function is poor, which make the tolerability of operation and intraoperative bleeding, oozing decreased. This study confirmed, the autologous blood transfusion machine application in the intraoperative of portal hypertension, the intraoperative blood loss to obtain timely recovery, transfusion, so that the operation process is safe, smooth. In clinic, it is an economic, practical, effective method.[Objective]To investigate the autologous transfusion technology in the devascularization operation of portal hypertension, the process of operation safety, practicality, effectiveness. And that analysis the Hb variation of acute check blood of postoperative, autologous blood transfusion quantity,respectively with splenic vein, spleen weight(after splenic blood transfusion), spleen size correlation.[Methods]Portal hypertension devascularization operation23patients, male17, female6, age (39.6+15.49), weight (61.05+16.97) kg. Doing autologous blood transfusion by using Cell Saver5+automatic blood recovery machine in the intraoperative, before the start of the operation, blood storage filter, blood recovery tank and a disposable pipeline was connected, the heparin solution100ml (25/ml) pre-flushing recovery system, to recover the100ml blood infusion of15～20ml heparin solution is preferred. The operation room negative pressure aspiration and blood storage tank is connected to the filter to generate negative pressure, the aspirator to operation wild bleeding, bleeding and spleen blood recycling to the blood reservoir preparation processing; recovery of blood storage, separation, washing, cleaning, draining, i.e., by Cell Saver5+type blood recovery machine automatic after treatment, the cell debris, free hemoglobin and anticoagulants such as separation to a waste bag. concentrated blood cells recovered to a blood storage bag, in intraoperative or postoperative transfusion to the patient, that is according to the recovery-processing-back transmission procedures.[Results]①In23patients with recovery of the original blood by Cell Saver5+type blood recovery machine processing and then autologous blood transfusion. In23patients, no allergic reaction, exothermic reaction, haemolytic reaction. No specific antibody immune responses induced by. Were cured.②In23patients with peri operation period, ALT, AST, K+、Na+, PT have no significant difference (P>0.05).③As compared with preoperatively, in the absence of homologous blood transfusion cases,the average red blood cell,hemoglobin and hematocrit of the postoperative acute check blood of23patients was increased by17%,18%,17%, but no significant difference (P>0.05)..④Postoperative acute blood test,the hemoglobin of18patients was higher than that of preoperative, and there was significant difference (P<0.05),that of other5cases was slightly lower than the preoperative, no significant difference (P>0.05).⑤In18cases of postoperative patients with elevated hemoglobin, in the bilateral inspection level:a=0.05cases, postoperative acute check blood Hb variation and splenic vein showed significant correlation (P<0.05), and the weight of the spleen(after splenic blood transfusion), spleen size correlation is not significant(P>0.05); autologous blood transfusion volume and spleen size was significantly correlated (P<0.05), and the splenic vein, spleen weight(after splenic blood transfusion) correlation was not significant (P>0.05).[Conclutions]①The application of autologous blood recovery machine in the devascularization operation of portal hypertension, which make the operation process is more safe, smooth, and it is economic, practical. At the same time, it avoided a variety of infectious diseases and adverse reaction from allogeneic blood input.②The wider of the splenic vein, the bigger of its affects on postoperative Hb variation; the greater of the spleen, the more of the amount autologous blood transfusion.