自体血洗涤回输对失血性休克患者术后炎症反应的影响  

Effect on Post-operative Inflammation after Intraoperative Blood Salvage in Hemorrhagic Shock Patients

作　　者：张穗[1] 高慧芳[1] 黄媛[1] 杨丽[1] 黎笔熙[1] 

机构地区：[1]广州军区武汉总医院麻醉科,湖北武汉430070

出　　处：《华南国防医学杂志》2010年第5期371-373,376,共4页Military Medical Journal of South China

摘　　要：目的观察自体血洗涤回输是否加重休克病人术后炎症反应和增加术后感染。方法 40例肝、脾破裂和黄体破裂休克患者,随机分为试验组(T组)和对照组(C组),每组20例;其中T组术中采用自体血洗涤回输技术,C组作为对照组酌情输注异体血。检测两组患者围术期中性粒细胞、C-反应蛋白(C-reactive protein,CRP)及体温变化趋势,并在术前、术后分别抽取动脉血样进行细菌培养。结果术后48h内两组患者中性粒细胞绝对数和百分率显著升高,并分别在术后1h(T组)和48h(C组)达峰值(P<0.05);术后T组中性粒细胞显著低于C组(P<0.05);两组患者术后CRP均明显升高,分别于术后24h和48h达峰值;术后24hT组CPR明显高于C组,但48～72h后则明显低于C组(P<0.05)。两组患者术后1～2天内腋温均有不同程度上升(P<0.05),至术后3天均下降至正常水平。自体血回输前后采集的患者血样细菌培养结果均为阴性。结论失血性休克患者外科止血手术中采用自体血洗涤回输技术是安全的,并不增加术后炎症反应和感染的机会。Objective To investigate the relationship between intra-operative autologous transfusion and post-operative inflammation and infection in patients with hemorrhagic shock.Methods Forty patients with hepatorrhexis,rupture of spleen and corepus luteum were randomly divided into trial and control groups. Intraoperative blood salvage was applied to the trial group （20 patients） using CellSaver device,and the other 20 patients served as control group. Heterophil granulocyte,C-reactive protein （CRP） and body temperature were detected intraoperatively.The artery blood was extracted for bacterial culture. Results The heterophil granulocyte was significantly elevated 48 hours postoperation in both groups （P0.05）,and attained to the peak 1 hour and 48 hours after operation in trial and control groups respectively. Heterophil granulocyte in trial group was less than that in trial group during 24-48 hours after operation （P0.05）. The CPR value rised obviously after operation in both groups,and attained to the peak 24 and 48 hours after operation in trial and control groups respectively. And the CRP value was higher 24 hours but lower during 48-72 hours after operation than in control group （P0.05）. The axil temperature raised （P0.05） in the first and second day and descended to normal level in the third day after operation in both groups. The bacterial culture results of the blood of the patients with intraoperative blood salvage were all negative.Conclusion Intraoperative blood salvage using CellSaver device does not affect post-operation systemic inflammatory response and does not increase the post-operative infection rate.

关 键 词：失血性休克 自体血回输 炎症反应 

分 类 号：R541.64[医药卫生—心血管疾病] R457.1[医药卫生—内科学]