去白细胞输血在小儿心脏直视手术中的应用研究  

Transfusion of leukocyte-depleted blood in pediatric open heart surgery

作　　者：于洋[1] 刘景汉[1] 欧阳锡林[1] 吕留彩[1] 韩玮[1] 李锡金[1] 

机构地区：[1]解放军总医院解放军临床输血中心,北京100853

出　　处：《中国输血杂志》2004年第3期155-157,共3页Chinese Journal of Blood Transfusion

摘　　要：目的　评价去白细胞输血在小儿心脏直视手术中减轻心肺组织损伤、降低术后感染率的效果。方法随机选取 344名择期在体外循环下行心脏直视手术的患儿 (术前无感染 ,心功能 >Ⅱ级 ) ,据术中输注血液成分的不同分为对照组 (未输血 ) 1 0 9人、常规输血组 (输注常规血液成分 ) 1 1 3人、去白输血组 (输注去白细胞血液成分 )1 2 2人 ,各组病例分别于术前、术后 6h、2 4h检测血清肌酸激酶同工酶 (CK MB)、门冬氨酸氨基转移酶 (AST)、乳酸脱氢酶 (LDH)、丙二醛 (MDA)水平 ,监测全肺阻力 (TPR)和呼吸指数 (RI)的变化 ,同时记录患者围手术期体温、外周血象变化及术后抗生素的使用天数。结果术后各组血清CK MB、AST、LDH、MDA水平较术前均明显提高 ,但各时向去白输血组血清 4项指标明显低于常规输血组 (P <0 .0 1或 0 .0 5 ) ;术中、术后去白输血组TPR和RI水平均低于常规输血组 (P <0 .0 1或 0 .0 5 ) ,与对照组比较无显著差异 (P >0 .0 5 ) ;去白输血组术后感染率及术后抗生素使用天数低于常规输血组 (P <0 .0 5 ) ,与对照组比较无明显差异 (P >0 .0 5 )。结论去白细胞输血在小儿心脏直视手术中可以有效地减轻心肺组织缺血再灌注损伤。Objective To evaluate the efffects of leukocyte-depleted blood transfusion the protection of cardio pulmonary tissue and the reduction of postoperative bacterial infection.Methods Three hundred and forty-four pediatric patients were allocated to one of 3 groups based on transfusing different components of blood during open heart surgery:control group(n=109),routing blood transfusion group(RBT,n=113),leukocyte depleted blood transfusion group (LDBT,n=122). Blood samples were taken before operation,at 6h,and 24h after operation fir determination of creatininee kinase MB( CK MB),aspartate transaminase(AST),lactate dehydrogenase(LDH)and MDA. At the same time,we monitored changes of TPR and RI,and recorded changes of body temperature and days of utilizing antibiotics after operation.Results After operation serum concentrations of CK MB,AST, LDH and MDA significantly increased in all groups as compared to the values before operation,but the values of those in group LDBT were significantly loert than those in group RBT(P<0.01 or 0.05).The levels of TPR and RI in group LDBT were lower than those in group RBT(P<0.01or 0.05).Bacterial infection rate and days of utilizing antibiotics after operation were significantly less in group LDBT compared to those of group RBT(P<0.05).No significant difference were detected in aforementioned indexes between group LDBT and control group(P>0.05).Conclusions Leukocyte depleted blood transfusion can effectively prevent the patients from cardion pulmonary ischemia-reperfusion injury and reduce postoperative bacterial infection in pediatric open heart surgery.

关 键 词：输血 去白细胞 心脏直视手术 缺血一再灌注损伤 术后感染 移植物抗宿主病 

分 类 号：Q274[生物学—细胞生物学] R457.1[医药卫生—治疗学]