局部麻醉.ppt

ZhangLanDepartmentofAnesthesiologyofWestChinaHospital,RegionalAnesthesia,ClinicalAnesthesia,GeneralAnesthesia,RegionalAnesthesia,Topicalanesthesia,Peripheralnerveblock,Localinfiltrationanesthesia,Spinal16(3):187-99.Transfusiontriggers:asystematicreviewoftheliteratureUSA（输血指征：文献的系统回顾）,检索了OVIDMedline数据库，近期期刊目录库，Cochrane数据库，和已发表文献目录。观察死亡率，心脏相关事件发生率，发病率，和住院时间没有受影响。结论：在有限的已经发表的证据支持在不合并严重心脏疾病的患者中采用限制性输血。,CritCare.2007Jun19;11(3):142Transfusiontriggerincriticallyillpatients:hasthepuzzlebeencompleted?重症患者输血指南：问题完全解决了吗？在稳定的危重病患儿采用以70g/L血色素为输血底限的限制输血方法能减少用血而不影响预后。该研究证实，试图通过输RBC来提高组织氧供是没有多大临床优势的。,Complicationoftransfusion,ImmunoreactionNon-immunoreaction,Hemolytictransfusionreaction,Allergicreactions,Nonhemolytictransfusionreactions,Feverreactions,AcuteHemolyticTransfusionReaction,DelayHemolyticTransfusionReaction,Transfusion-InducedImmuno-depression,Transfusion-RelatedAcuteLungInjurymyocardialinjury,Immunoreaction,Acutehemolytictransfusionreaction,Afatalreactions，mortalityrate20%to60%TherenalandcoagulationsystemsareaffectedABO-incompatibleThereactioncanoccurfrominfusionofaslittleas10mLofblood,SignsandSymptoms,Theclassicsignsandsymptomschillsfeverchestorflankpainnausea,Thesignsingeneralanesthesiableedinghypotensionhemoglobinuria,Delayedhemolytictransfusionreaction,unexplainedfeverandanaemia7to14daysafteratransfusionRh-incompatiblerarelydeath,Non-immunoreaction,Hepatitis,Inthe1940s,viralhepatitiswasrecognizedasamajorcomplicationoftransfusion.Now,theincidenceofposttransfusionhepatitisBhasdramaticallydecreased.90%posttransfusionhepatitisiscausedbythehepatitisCvirus.,AcquiredImmunodeficiencySyndrome,AIDSismostfrequentlytransmittedbyintimatehomosexualcontactandintravenousdrugabuseWholeblood,plasma,bloodcellularproducts,orclottingfactorscantransmitAIDS.TheantibodiesoftheAIDSvirus(humanimmunodeficiencyvirustype1HIV-1)hasdramaticallyreducedtheincidenceoftransfusion-transmittedAIDS.,Preoperativeautologousblooddonation(PABD)AcutenormovolemichemodilutionIntraoperation&postoperationbloodrecovery,AutologousTransfusion,Preoperativeautologousblooddonation(PABD),Acutenormovolemichemodilution,Intraoperation&postoperationbloodrecovery,References,外科学7年制规划教材2002年第一版ANESTHESI