Study On The Safety Of Blood Recovery In Closed Abdominal Organ Rupture And Massive Hemorrhage

Objective: To study the safety of intraoperative salvage autotransfusion(ISA)within 48 hours of closed intra-abdominal rupture and massive hemorrhageMethods: The objects of the study were divided into two parts,and each part was divided into four groups,which was done according to the bleeding time of the closed intra-peritoneal internal organs.Group A was <6h,group B was 6-12 h,group C was 12-24 h,and group D was 24-48 h.In the first part,28 patients getting the surgery from January 2017 to June 2017 in the emergency department were selected.The hematocele and washed blood of the patients in the four groups were separately collected as samples,where the microbial culture(anaerobic bacteria,aerobic bacteria)+ drug sensitivity tests were conducted respectively.In the second part,60 patients getting the surgery from July 2017 to December 2018 in the emergency department were selected.In this part,the values of Hb,Hct,PaO2,PLT,PT,APTT,FIB,K+,Na+ and Cl- in the patients' venous blood were examined before the surgery and 24 hours later after the surgery.In addition,the amount of WBC,NEU,CRP in the patients' venous blood were examined as well before the surgery,24 hours and 72 hours later after the surgery.Result: 1.The results of the microbial culture cultivated on the blood samples of the 28 patients in part 1 showed that there was no bacterial growth in the hematocele and washed blood samples except 1 case of hematocele in group C where staphylococcus epidermis were found.As soon as the microbial culture instrument indicated the appearance of staphylococcus epidermidis,blood culture was performed on the related patient for 3 consecutive days,and all the results of the cultures were negative.2.The effects that ISA has on all the blood indexes of the selected patients with closed intra-abdominal organ rupture and hemorrhage within 48 hours:(1)The values of Hb,Hct and PLT of all the patients in the four groups decreased 24 hours later after the surgery of ISA,compared with those values gotten before the surgery,and the differences between them were statistically significant(P<0.05).Meanwhile the differences in Hb,Hct and PLT values between group A and group B,C and D 24 hours after the surgery were not significant(P>0.05).(2)The values of Pa02 of all the patients in the four groups increased 24 hours later after the surgery of ISA,compared with those values gotten before the surgery.The differences here were statistically significant(P<0.05).While the differences in Pa02 values between group A and group B,C and D 24 hours after the surgery were not significant(P>0.05).(3)The values of PT and APTT of all the patients in the four groups were prolonged 24 hours later after the surgery of ISA,compared with those values gotten before the surgery,and the values of FIB were decreased after the surgery,compared with those values gotten before the surgery.The differences here were statistically significant(P<0.05).However,all the coagulation indicators were within the normal range.And no significant differences in PT,APTT and FIB values between group A and group B,C and D 24 hours after the surgery were found(P>0.05).(4)Compared with those values gotten before the surgery,the values of K~+,Na~+,and Cl~- examined 24 hours later after the surgery of ISA of all the patients in the four groups were not significantly different(P>0.05).There were no significant differences in K~+,Na~+ and Cl~- values between group A and group B,C and D 24 hours later after the surgery(P>0.05).(5)The values of WBC,NEU and CRP of all the patients in the four groups increased 24 hours later after the surgery of IAS,compared with those values gotten before surgery.The differences here have statistics significance(P<0.05).72 hours later after the surgery,the values of WBC,NEU and CRP were slightly higher than those gotten before the surgery.The differences here have statistics significance(P<0.05).No significant differences in WBC,NEU and CRP values between group A and group B,C and D 24 hours later after the surgery and 72 hours later after the surgery were found(P>0.05).Conclusion: 1.One case of staphylococcus epidermidis was cultured from one 12-24 hours hematocele sample among all the samples from the 28 selected patients with closed intra-abdominal organ rupture and hemorrhage within 48 hours.While no other bacteria were found in the rest of the hematocele samples and washed blood samples.So pollution of the sample can be taken into consideration.2.ISA works effectively on the patients with closed intra-abdominal organ rupture and hemorrhage within 48 hours.Meanwhile,ISA has little influence on both the coagulation function and electrolyte.It can also inhibit postoperative inflammatory reaction to some extent.