术前预存式自体输血联合术中自体血回输在复杂脊柱手术中的应用效果

doi:10.3969/j.issn.1671-2587.2018.04.014

临床输血与检验 ›› 2018, Vol. 20 ›› Issue (4): 380-383.DOI: 10.3969/j.issn.1671-2587.2018.04.014

术前预存式自体输血联合术中自体血回输在复杂脊柱手术中的应用效果

郭芳,葛亚丽,陈小萍

225000 扬州大学临床医学院（江苏省苏北人民医院）麻醉科

收稿日期:2018-02-11 出版日期:2018-08-20 发布日期:2018-08-14
通讯作者: 陈小萍,女,主治医师,硕士,主要从事围术期血液保护工作,（E-mail）330989007@qq.com。
作者简介:郭芳（1971–）,女,江苏扬州人,副主任医师,学士,主要从事围术期自体输血工作,（E-mail）gf197110@163.com。

The Efficacy of Pre-storedAutologous Whole Bloodand its Intraoperative Blood Transfusion in Complex Spine Surgery

GUO Fang,GE Ya-li,CHEN Xiao-ping

Department of Anesthesiology of Clinical Medical School,Yangzhou University Affiliated Hospital （Northern Jiangsu People,s Hospital）,Yangzhou 225000

Received:2018-02-11 Online:2018-08-20 Published:2018-08-14

摘要/Abstract

摘要： 目的探讨术前预存式自体输血联合术中自体血回输在复杂脊柱手术应用中是否可以取代异体输血，观察术后炎性因子的动态变化。方法选择全麻下行复杂的脊柱外科手术40例，随机分成异体组和自体组（n=20），异体组患者围术期仅输入异体血，自体组患者术前1周预存自体全血400 mL，并在术中使用自体血回收机回收手术野的失血，处理后室温保存在血袋中，术中回输给患者。所有患者均于麻醉诱导后即刻（T1）、输血前（T2）、输血后（T3）抽取动脉血行血气分析，并留置5 mL血标本于抗凝试管中；所有患者在术后第1天（T4）、第4天（T5）、第7天（T6）清晨采集静脉血，检测患者血常规，并留置5 mL血标本于抗凝试管中。所有抗凝管血标本经离心后保存在–80℃冰箱，采用ELISA法检测炎症因子IL-6、TNF-α、IL-4、IL-10。结果患者术后血红蛋白值与术前相比均明显降低（P＜0.05），术后白细胞数值与术前相比均明显升高（P＜0.05），但两组间差异无统计学意义。与术前相比，两组IL-6浓度在T5时间点明显高于T1，TNF-α、IL-10浓度在T4、T5两个时间点均明显高于T1（P＜0.05）；与异体组相比，自体组IL-6浓度在T5两个时间点明显低于异体组，IL-4浓度在T5、T6两个时间点明显低于异体组，TNF-α、IL-10浓度在T4、T5两个时间点明显低于异体组（P＜0.05）。结论围手术期联合术前预存自体血和术中自体血回收技术，在复杂脊柱外科手术中使用可以减少异体血的使用，节约血资源，且有助于调节机体促炎-抗炎反应平衡，为临床血液保护提供一个可参考的方向。

关键词: 预存式自体输血, 自体血回输, 炎症因子, 白细胞介素, 肿瘤坏死因子α

Abstract: Objective To studythe pre-storedautologous whole bloodin stead of allogeneic blood transfusionapplied in complex spine surgery and observethe dynamic changes of postoperative inflammatory factors. Methods Fortypatients with complex spine surgeryunder general anesthesia were randomLy divided into autologous group （auto-G） and allogeneic group （allo-G）（n=20）. Patients in allo-G only received allogeneic transfusion whereas patients in auto-G pre-deposited400mLof theirwhole bloodbefore oneweek of operation and received transfusion of intraoperative salvage of shed blood. Serum IL-6，TNF-α，IL-4，and IL-10 were measured immediately after anesthesia（T1），before transfusion（T2），after transfusion（T3），on 1d（T4），4d（T5）and 7d（T6）after operation by ELISA.Blood routine tests were recorded on the days of 1，4，and 7 after operation. Results Postoperative Hb level decreased obviously（P＜0.05）while WBC notably increased in all patients of the two groups（P＜0.05）but no difference was seen between the two groups. On 4 d after operation，IL-6 were significantly higher than that in immediately after anesthesia in two groups（P＜0.05）Serum level of TNF-αand IL-10 on 1d and 4d after operation were significantly higher than thoseon the dayofanesthesia in two groups（P＜0.05）.On 1d and 4 d after operation，TNF-αandIL-10 production in auto-G was lower than that inallo-G（P＜0.05）. On 1d after operation，IL-6 in auto-G was lower than that inallo-G（P＜0.05）whileIL-4 in auo-G was lower than that in allo-G when tested on 4 d and 7 d after operation（P＜0.05）. Conclusion Pre-stored autologous whole bloodcombined with intraoperative autologous blood can reduce the amount of allogeneic blood use to save blood resource，and may help prevent adverse reaction following transfusion.

Key words: Predeposited autologous transfusion , Autologous blood transfusion, Inflammatory factor , Interleukin, Tumor necrosis factor -α

中图分类号:

R457.1 R466.11

郭芳,葛亚丽,陈小萍. 术前预存式自体输血联合术中自体血回输在复杂脊柱手术中的应用效果[J]. 临床输血与检验, 2018, 20(4): 380-383.

GUO Fang,GE Ya-li,CHEN Xiao-ping. The Efficacy of Pre-storedAutologous Whole Bloodand its Intraoperative Blood Transfusion in Complex Spine Surgery[J]. JOURNAL OF CLINICAL TRANSFUSION AND LABORATORY MEDICINE, 2018, 20(4): 380-383.

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术前预存式自体输血联合术中自体血回输在复杂脊柱手术中的应用效果

The Efficacy of Pre-storedAutologous Whole Bloodand its Intraoperative Blood Transfusion in Complex Spine Surgery

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