白细胞滤除对大出血手术患者自体血回输时诱发肺损伤的影响  

Effects of leukocyte-depleted intraoperative salvaged blood on lung injury in patients undergoing major operation with massive bleeding

作　　者：韩志强[1] 于建设[1] 龚玉华[1] 温再和[1] 

机构地区：[1]内蒙古医学院第一附属医院麻醉科,呼和浩特市010059

出　　处：《河北医药》2009年第22期3033-3035,共3页Hebei Medical Journal

摘　　要：目的探讨使用白细胞(WBC)滤器对大出血手术患者在行自体血回收时诱发肺损伤的影响。方法选择预计大出血手术需进行自体血液回输患者24例,随机分为对照组(C组)和WBC滤除组(T组),每组12例。C组不使用WBC过滤器,T组于泵后串联一个WBC过滤器,分别于自体血回输前即刻、回输后30min、60min、6h、12h抽取动脉血3ml,检测计数WBC和中性粒细胞(PMN)、超氧化物歧化酶(SOD)活性、丙二醛(MDA)、血浆肿瘤坏死因子(TNF)-α、白细胞介素(IL)-6和IL-8的浓度、中性粒细胞弹性蛋白酶(NE)。并进行血气分析,计算呼吸指数(RI)和肺顺应性(CL)。结果与C组比较,T组于自体血回输后各时点WBC和PMN计数降低,血浆NE、MDA浓度和RI降低,血浆SOD活性升高,血浆TNF-α、IL-6、IL-8浓度降低(P<0.05);T组CL高于C组。结论滤除WBC的自体回收血可减轻自体血回输时对肺的损伤。Objective To investigate the effects of reinfusion of leukocyte-depleted intraoperative salvaged blood on lung injury in patients undergoing major operation with massive bleeding. Methods Twenty four patients undergoing major operation that was anticipated to cause massive bleeding during operation including large liver hemangioma and closed liver and spleen rupture were randomly divided into 2 groups （n=12,in each group）：control group （group C） and leukocyte depletion group （group T）. Anesthesia was induced with midazolam,fentanyl,propofol and succinyl choline and maintained with isoflurane inhalation and intermittent iv boluses of fentanyl and vecuronium. The patients were mechanically ventilated after tracheal intubation （VT =8~10ml/kg,RR=12bpm,I∶ E = 1∶2）. Radial artery and right interval jugular vein were cannulated for continuous BP and CVP monitoring and blood sampling. Intraoperative blood salvage and reinfusion were performed in all patients by using cell saver system. In group T the salvaged blood was fittered with a leukocyte depleting filter placed in the line of the reinfusion circuit. Blood samples were taken from radial artery immediately before the shed blood was reinfused （baseline） and at 30 min,60 min,6 h and 12 h after reinfusion for detecting the plasma concentration of TNF-α,IL-6,IL-8,NE,MDA and SOD activity,total leukocyte count,and blood gas analysis.Respiratoryindex（RI） and pulmonary compliance（CL）were calculated. Results As compared with those in group C,the WBC and PMN counts were significantly decreased compared with the baseline values in group T at different time points after autoblood retransfusion,the plasma concentrations of NE,MDA,TNF-α,IL-6,IL-8 and RI significantly decreased （P〈0.05）,however,the activity of SOD and CL in group T were higher than those in group C.Conclusion Reinfusion of leukocyte-depleted intraoperative salvaged blood can reduce acute lung injury caused by reinfusion of intraoperative salvaged blood.

关 键 词：输血 自体 白细胞去除术 呼吸窘迫综合征 成人 

分 类 号：R654.1[医药卫生—外科学] R563[医药卫生—临床医学]