骨科手术中自体血液回输对血清前炎性细胞因子浓度的影响  

Effects of autologous blood transfusion on serum cytokine levels in patients undergoing lower limb orthopedic surgery

作　　者：安尔丹[1] 龚遂良[2] 肖旺频[1] 周清河[1] 沈颖彦[1] 

机构地区：[1]浙江省嘉兴学院附属第二医院麻醉科,314000 [2]浙江省嘉兴学院附属第二医院骨科,314000

出　　处：《中华实验外科杂志》2011年第4期630-631,共2页Chinese Journal of Experimental Surgery

摘　　要：目的测定下肢骨科手术术野回收血经自体血回收机处理前后及患者自血回输前后血清前炎性细胞因子浓度，观察骨科手术中自体血回输对患者细胞免疫的影响。方法30例择期行下肢骨科手术患者，分别采集自体血回收机处理前后的术野回收血，并于自体血回输前10min、回输后1h采集患者动脉血，采用放射酶联免疫吸附测量法测定血样中3种前炎性细胞因子白细胞介素（IL）-1β、IL-6、肿瘤坏死因子（TNF）浓度，并观察相关并发症。结果术野回收血经自体血回收机处理前后3种前炎性细胞因子IL．1B、IL-6、TNF浓度分别为（0．54±0．22）、（0．71±0．16）、（16．23±5．68）μg／L和（0．26±0．12）、（0．29±0．09）、（6．32±2．57）μg／L，与处理前比较，处理后3种细胞因子浓度显著降低（P〈0．05）；自血回输前后患者血清中3种细胞因子IL-1β、IL-6、TNF浓度分别为（0．35±0．17）、（0．47±0．15）、（8．44±3．56）μg／L和（0．39±0．19）、（0．52±0．18）、（9．48±3．45）μg／L，与回输前比较，回输后患者血清中3种细胞因子浓度增高（P〈0．05）；30例患者自体血回输后12h内均未观察到低血压、心动过速、血红蛋白尿、凝血功能紊乱、脓毒血症、空气栓塞、心肺问题等并发症。结论骨科手术患者术中可适量自体血回输，回收血液经自体血回收机处理后前炎性细胞因子浓度显著降低，回输后未观察到严重并发症。Objective To investigate the effects of autologous blood transfusion on serum cytokine levels in patients undergoing lower limb orthopedic surgery. Methods A total of 30 cases scheduled for undergoing lower limb orthopedic surgery were enrolled in this study. Each patient had four blood samples taken （pre-transfusion, one h post-transfusion, cell saver container, and post-filtration from the blood bag）. An enzyme linked immunosorbent assay （ELISA） measurement of radiation was conducted to deter- mine levels of the cytokines interleukin （IL）-1β, IL-6 and tumor necrosis factor （TNF）. Serious compli- cations and sequelae associated with autotransfusion were recorded. Results In comparison to cell saver container, levels of IL-1β, IL-6 and TNF in the blood bag were decreased significantly （ P 〈 O. 05 ）. In comparison to pre-transfusion, levels of IL-1β, IL-6 and TNF were increased significantly （P 〈 0. 05）. No serious complications and sequelae associated with autotransfusion were observed. Conclusion The use of cell saver container appears to be safe in patients undergoing orthopedic surgery and the levels of the cyto- Lines in post-filtration blood are decreased.

关 键 词：自体血液回输 细胞因子 骨科手术 

分 类 号：R687[医药卫生—骨科学] R457.1[医药卫生—外科学]