Y HQC Vlf T NAM THANG 8 • S6 BAC Bif T/2012
SUTDUNG MAY TRUYlN M A U HOAN H(!| TRONG PHAU THUAT VA H 6 | SlUC TAI BlNH VieNGH0R/iY
Phfm Thp Tuin Anh, Biki Quic Thing, Nguyin Bio Tjnh (*)
SMTAT
Md dSir. Trong tinh hinh khan hiim miu
^n nay, vifc sir dyng miu cua chinh bfnh nhin St dl trong phiu thuft d f truySn lai cho bfnh lin oi y nghia rSt quan tnjng. Mft s5 trudng Jp: phiu thuft bfnh ly dfng m?ch chd, phiu mat dm, phau thuft cip curU: xuit huyit nfl, k thucfng dm, die blft la trang mft sd trudng dp chiy mau giai doan hfu phau, cd lUpng miu lit di khi nhieu, can dUdc t i l sir dyng.
Mpc OSu nghien ciiif. Cinh gia kit qui v i II Idi hong viec sd dung miy truyen mau hoan ii bong phau thuft v i hfu phau.
Pht/tfng phip nghien cCru: Tong kit kit ua sii dung miy truyen mau hoan hdi trong 17 ndng hpp phau thuft benh ly dfng mach chu giTc doan xuong. Danh gia hifu qua sir dung nng phau thuat cap cihi va cham sdc hau phau . Ket qua: LUdng mau mat di trong phiu rtt hung binh 2984,7 ml, ludng miu truyen lai io benh nhan trung binh la 1771,8 ml. So luHng lau an truyen thim cho bfnh nhin glim nhieu, 'S 4 tnidng hpp khdng ran truyen them miu. Sd (ng trong 1 trudng hdp cap aiu vet thUdng
*n, 1 hudng hpp xuat huyit nfl, 1 frUdng hpp leodoi hau phau.
Bin lufm Sis dung may truyen miu hoan ' l bat cfiu dupe ap dung tai bfnh vifn Chp Ray ' thing 4 nam 2008 va budc iKu cho thay 'iieu Ipi ich cho binh nhan va giim ginh nfng
• iiu miu hiin nay. Cd the ap dung rpng rai de tan 'JngkiBngmiumatdi.
if fi'khda:truven miu hoan hoi
ABSTRACT
WORKING WHH AUTOLOGOUS BLOOD RECOVERY SYSTEM IN PERIOPEARATIVE
CARE AT CHO RAY HOSPITAL Background: Now, there are a great need for blood, the recovery of blood shed during an operation and then reinfuse to the patient is very Important. Some cardiac vascular surgery, emergency, perioperative care, the blood shed need to refuse.
Methods: report of 17 case of descending aortic surgery which use autologous blood recovery system. Use In emergency surgery and perioparative care.
Result: the blood have been collected, average 2984,7 ml, and then reinfusion is average 1771.8 ml. Decrease the homologous blocxi need to transfuse and 4 cases were not need to Uansfuse. Used in 1 emergency heart injury, 1 haemorrhage, 1 periopecative care.
Comdusbrr. Autologous blood recovery system has used at Cho Ray Hospital from April 2008. We see a lot of benefit for patient and blood bank. It may be now widely accepted In some specific types of surgery need to recovery the blood shed.
/reywoRi!;: autologous, cell saver.
I. T 6 N 6 QUAN
Truyin miu ty thin hifn nay dupe chip nhfn rpng rii, dugc xem nhu li lya chpn diu tiin khi quyit djnh truyin miu niu cd diiu kien. Miu ty than im chi miu dupe liy ra tCr
& Khoa Hoi Slit Phiu Thuat Tim - Benh vlfn Chd Ray . g W f n khoa hpc: TS. NguySn Trudng Son
CHUYfiN BJ: H Q I N 0 H | KHOA HQC HUYgl HQC - TRUYGN M A U T O A N Q U 6 C 2012
chinh bfnh nhin. Truyin miu t\r thin nghia li bfnh nhin duprc hnyln Iji miu cda chinh hp.
Truyin miu ty thin rit cd Ipi;
• Khdng cd nguy co mic cic bfnh ttuyin nhilm;
• Khdng cd phin ung do truyin miu;
• Giam ip lyc cho ngin hing miu...
Trong tinh hlnh khan hilm miu hlfn nay, vifc sd dyng miu cCia chinh bfnh nhin mit di ttong phiu thuft, vi din luu trong hii siic dl ttuyin lai cd y nghTa rit quan trpng.
Mft sl ttudng hpp: phiu thuft bfnh ly dfng mach chd, phiu thuft tim, phiu thuft cip cuu: xuit huyit nfi, vlt thuong tim, dfc bift li trong mft sl trudng hcjrp chiy miu giai do^n hfu phau, cd lupng miu mit di khi nhiiu, cin ducprc tii sir dyng.
Su dyng miy truyin miu hoin hii trong trudng hpp niy, giup nhanh chdng xu ly lupng miu mit di nhim kjp thdi truyin l^i cho ijfnh nhan. Miu sau khi xu ly cd chit lupng tdt: loai bd cac chit df m hong ciu (red cell sbvma), hemoglobin ty do trong huyit tuong, cac chat chong ddng miu, cic yeu to ddng miu, Kali ngoai bao ...
Khdng dung miu bj nhiem khuin, miu chiy td vung nghi ngd cd khoi u ic tinh, miu chiy ra qui 6 gid.
II. MVC TIEU - OdI TUQNG - PHUONG PHAP NGHIEN CCfU
Mpc tiiu nghiin cuu: Dinh gia kit qui vi Icjri ich trong vifc su dyng miy truyin miu hoin hii trong phau thuft vi hfu phau
Dii lupng nghien cuu: Tit ci nhOng bfnh nhan phau thuft tim mach tfii Khoa Hoi sue Phau thuft tim Bfnh vifn Chp Ray dupe su dyng may truyin mau hoin hdi. TCr thing
4/2008 tdi 10/2008 cd 17 midng hpp. Skt gii hifu qui sCr dyng trong phiu thuft df cdru vi chim sdc hfu phiu
Phinmg phdp nghiin cOu: tiln ciru, c^
ngang md ta
Phuorng lifn: Miy truyin mau hoan b^
Cell Saver CD5+. Su dyng cdng nghf vi at ly mdi nhit giup vfn hinh chi df ty dfngd cip dp cao. Su dyng cic bp nhan cam gnip giim tii thiiu'qui trinh quan sit vi dieu khiin, ty dpng dinh gii thi tich djch trong binh chda vi khdi dfng quy trinh. Rut ngin thdi gian xu ly mi van mang lai chit Iir^ng sin pham cuoi cung tdi uu. Miy Haemonetic Cell Saver 5-i- duijrc dung dl khdi phyc lai lui;mg miu mit khi mo. Lupng miu mat 4 duc;rc hut ve binh chila cung vdi heparin, sau dd ducjTc quay ly tim gid l^i ti bio hong can, tiip dd nia sgch di cic tl bio nin, tieu can, yiu tl kich hoat ddng miu. Kali ngoai bao, Hemoglobin ty do, chit chdng ddng va dung dich lift tim ... Sau khi nia hdng cau se duoc truyen cho bfnh nhan.
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Y HQC VlfT NAM T H A N G 8 - S O B A C BlfT/2012
il QUA
Trong 17 ttudng hc;)p phau thuft dfng mfich chd ngyc xuing chdng tdi nhfn thiy:
Bing 1: Thdng tin vl bfnh nhin SIT
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17
SNV 27414 37017 45037 51067 59077 61772 64012 65974 65376 67373 77270 75730 75299 77680 81537 82923 81690
TU6l 42 56 37 28 39 73 47 47 78 57 74 44 57 59 20 73 47
G l d l NAM NU' NO NO' Nijr NAM
NO' NAM NAM NAM NAM NO NAI«I NAI^
NAM NAM NAM Bing 2 Kit qua hoat dpng cua miy trong phau thuat
STT 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17
HUTVE(ml) 3073 4851 3344 3120 3260 3600 2910 1400 5200 2600 1260 2300 1781 2181 2860 3400 3600
TRUYEN LAI (ml) 1357 2904 1662 2100 2260 2320 1820 810 3500 1420 870 1670 1174 1454 1600 1500 1700
TRUYEN MAU (ml) 1800 2050 2200 2150 500 2100 1050 0 2300 2600 0 0 0 350 1850 1250 2100
CHUYfeN Bi: Hpl NOHI KHOA HQC HUYgT HQC • TRUYEN MAU TOAN QUtfC 2012 Bing 3: S l lifu Cmg dyng m i y truyin m i u hoin h i i ttong phau thuft
Lul^ng djch tmng hlnh LuVng d|ch tdl da
Ldifng d|ch tdl thiiu
HdtvV (ml) 2984.7
5200 1260
TruySn Ifi (ml) 1771.8
3500 810
LU^ng miu truySn t h i m (ml)
1715.4 2600
350
TCing lu'dng miu dl truySn (ml)
3083.6 5800 810
Bing 4: Cic chi s l huyit hpc trudc v i sau m l Het trunq binh
Co chi dinh truyen miu Na*<135mEa/l K*<3.5 mEq/l Ca"<3.5 mEq/l Cl"<90 mEq/l
Tru'dc md 34.5%
3ca 6 ca 3ca Oca 3ra
Sau md 37.2%
lea 3ca 4ca 4ca lea Bing 5: Sy thay d l Creatinnin trudc v i sau m l
Cie trUdc mS (mgo/o)
>1.5
>1.5
>1.5
<1.5
<L5
<1.5
Ore sau md (rnqVa) Tinq Giam, >1.5 Glim, <1.5 Tinq, >1.5 Tinq, <1.5
Glam
Sdca 1 0 1 2 7 6 Mpt trudng hpp phiu thuft c i p cdu vlt
thuong tim duc^c phau thuft t?i phdng mo cap cuu khoa cip cdu bfnh vifn Chp Ray, kip thdi ttuyin lai lupmg m i u m i t cho bfnh nhan.
Mpt ti^tdng hpp xuit huyit npi do vd phinh dpng mgch chu byng.
Mpt trudng hpp sd dyng tiii phdng hoi sue phiu thuft tim, truyin lai m i u hut tu ong dan luu cua benh nhan hfu phiu bdc tich dpng mach chu ngue cd rdi loan ddng mau nang.
IV. BAN LUAN
Chiing tdi theo ddi 17 ttvdng hpp phil thuft dfng mach chu do?n xuing sd dimg m i y truyin m i u h o i n hdi, 11 lif nh nhan 14 nam (64,7%); df tudi trung binh l i 51,6, can nhit 78 tudi, thap nhit 20 tudi.
Tu kit qua trin cho thiy, Iupng mau mat di ttong phau thuft dpng mach chu ngvc xuong l i kha ldn, trung binh 2984,7 ml. Si dyng lucjng m i u nay d l xir ly v i truyin '(i cho bfnh nhan khdng chi mang l?i co Ipi«
mft y hpc truyin mau ty than, ho ttp cho gay me hoi sCrc m i cdn mang l^ii Ipi ich ve kinh
362
Y Hpc VigT NAM T H A N G 8 • S 6 ' D A C BlgT/2012
i, d6ng th6i g i ^ gdnh n?lng cho ngan hkng mdu.
Lugng mdu sau khi mdy xii 1;^ vd truyen l^i cho b^nh nhdn trung binh 1771,8 ml, ddy la mpt con so rat c6 y nghia, ldm gidm ddng k^ s6 Im^ng mdu cAn truyen them, vl thi trong mpt so truing hgp chi chn truyen mdu hoan h6i ma khong c4n sii dyng them mdu tix Dgan hang mdu.
d nhihig b?nh nhdn c6 truyen thSm mdu, so lugng mdu cCmg nhdm tucmg dong c ^ tmySn them trung binh Id 1715,3 ml. Trong khi d6, tSng lugng mdu c4n truyen cho b$nh nhan trong su6t ph§u thu^t trung binh Id 3083,6 ml g4n tuorng ducmg vdi lugng mdu mSt di. Ta thiy lugng mdu truyen hodn hoi, trung binh la 1771,8 ml, chiem t6i t6i 57,5%.
Dieu d6 cho thay vi^c truyen mdu hodn hoi da giai quyet rat tot tinh tr^g khan hiem mdu hi?n nay, gidm ddng ke vi$c truyen mdu ciing nhom tucmg ddng.
Cdc truong hgp c6 lugng mdu mdt it Id do thuang ton doti gidn, phau thugt vien nhanh chdng ki£m sodt cdc vj tri chdy mdu.
Co 3 tnrdng hgp lugng djch mdu mdt dudi 2000ml vd 2 trudng hgp lugng mdu truyen 1^ dudi IDOOml va 2 trudng hgp nay deu khong cdn phdi truyen them mdu. Cd 4 trudng hgp khdng truyen them mdu cimg nhom tuong ddng, chi can tan dung lugng mdu chdy ra, xu ly vd truyen lai, chiem 23.5%.
Moi chu trinh xur ly chi ton thdi gian khoang 2-3 phut. Ngdn hom rat nhi^u so vdi thdi gian ddt mdu tir ngdn hdng vd kiem tra trudc khi truyen. Do do viec truyen mdu hoan hdi khong chi mang Igi Igi ich ciia vi?c truyin mdu tir than ma cdn kip thdi cung cdp mau cho qud trinh gay me hdi sue, nhanh chong 6n dinh tinh trang huy^t dong cua
b$nh nhdn khi m4t mdu nhiiu trong qud trinh phSu thugt.
Tuong quan giaa lugng dich mdu hut vk vk lugng mdu truyin Igi tixy timg b?nh nhdn, 1^ thugc vdo Het cua benh nhan vd s6 lugng hong cku trong lugng mdu mit di. Mdy s6 xii ly vd cho ra sdn pham c6 chit lugng t6i uu nhit do c6 nhieu trudng hgp lugng djch mdu mit khdc nhau nhung cd lugng mdu truyin Igi gin giong nhau.
Het trung binh trudc mo 34,5% vd sau mh Id 37,2%, tnrdc mo cd 3 trudng hgp cd chi djnh truyin mdu (Het <25%, Hb < 8g/dl), sau m6 cd 1 trudng hgp cd chi djnh truyen mdu. T6ng lugng mdu can truyin cho b$nh nhdn trong su6t phiu thuat trung binh Id 3083.6 ml, tucmg ducmg lugng mdu mit di Id 2984.7 ml, dieu dd chiing td sdn pham mdu sau khi dugc xtr ly qua mdy cd chit lugng tot, giup phuc hoi dugc lugng mdu mdt di, dn dinh dugc Het.
Ion do mdu khdng cd s\r thay ddi ddng kl sau md, c6 the do qua rinh gay me hdi siic dd diiu chinh rdi loan nude diSn gidi hi6u qua va vi?c sii dung mdy truyen mdu hodn hdi khdng dnh hudng nhieu den di?n gidi ciia benh nhdn. Tir bdng 3 ta thay, Na^ vd Cl" cdi thi?t tdt, sau md cd 4 ca cd K^ gidm <3.5 mEq/l {trudc mo la 3 ca), nhung vin >
3mEq/l; rieng Ca^* cd 4 trudng hgp giam nhung van >= 3mEq/l.
10 ca cd Creatinin sau md tdng so vdi trudc mo, nhimg 7/10 ca Creatinin van trong miic gidi hgn binh thudng, trong 3/10 ca sau md cd Creatinin > 1.5mg% cd 1 trudng hop Creatinin trudc md >1.5mg%. 1 trudng hgp tniac md cd Creatinin > 1.5mg% sau mo trd vl gia tri binh thudng. Ta nhdn thdy viec sii dung mdy truyin mau hodn hdi khdng cd ddu hieu gay suy than cho benh nhan.
CHUYgN Bi: Hpl NOH| KHOA HQC HUV^T HQC • TRUYEN M A U T O A N QUtfC 2012
Sd dyng m i y O^yln miu hoin hii trong dfc bift nhu ghip gan ... niu khdng cj cic ttudng hi?p phiu thuft c i p ciiu: vlt ching chi djnh ttuyin m i u hoin hii.
thuong tim, xuit huyit nfi v i hfu phiu giiip
mang lai hifu qui hii sdc tit, bli hoin thi TAI U ( U THAM KH&O
tich kip thdi, hifu qui. I. Trin Th| Ngpc Thu "Truyin miu vic:ictii biin truyin miu", i^li sue Cip cihi n^i khoa, V, K ^ T L U A N nhi xuit bin, trang 92-104
Sd dyng miy truyin miu hoin hii bit 2. Robert M.BoJar, "Mediastinal Bleeding", diu ducTC ip dyng tai bfnh vifn Chp lily tu Manual of Perioperative Care in Adnli thing 4 nim 2008 cho din nay v i budc diu Cardiac Surgeiy, Fourth Edition, Chapter 9, cho thiy hifu qui rit tit trin bfnh nhin v i Pages 2 6 7 - 2 8 4
giim ginh nfng khan hilm miu. 3. Julian C. L. Wong, FRCS, Francesco Bfnh nhin dupe hudng nhiiu Ipi Ich td Toreiia, FRCS, Sarah L. Hayio, PbS, vifc ttuyin miu ty thin, ding thdi cd thi tfn KIrsleen Dalrymple, BSc (Horn), Andim dyng gin nhu toin bf lupng miu mit di. H i J. Mortimer, FRCA, Charles N.
trp tich eye cho qui trlnh g i y m i hoi sue jVfcCollum, FRCS, and on behalf of die ttong vifc In djnh huyit dfng khi mit miu ATIS Investigators, "Autologous Venus s l lupng Icin. Vifc niy cd y nghta rit Ic^ Allogeneic Transiiision in Aortic Surgeiy".
ttong vifc tilt kifm chi phi m l , giim truyin httD://www.Dubmedcentral.nih.eov/articleiai miu cung nhdm tuong ding, do dd giim der.fci!i?ai1id=l422408
ginh ning lin ngin hang miu v i gdp phin 4. F. Torella, S. Haynes, C. Kirwan, A. Bbxt, khdng nhd cho thinh cdng cua phau thuft. C. McCollum, "Acute normovoletnic
Vifc su dyng miy truyin miu hoin hoi hemodilution and Intraoperative cell salvage cin dupe ip dung rpng rii trong c i c phiu In aortic surgery". Journal of Vasculir thuft cd chiy nhiiu miu nhu trong phiu Surgery, Volume 36, Issue 1, Pages 31-34, thuft tim mach, phau thuft ting quit cd vS hnp://linkinghub.elsevier.cnm/reuieve/Dii/SO tang, xuat huyit nfi hay trong cic phau thuft 741521402000046
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