滤除白细胞自体回收血对围术期患者红细胞免疫功能及全身炎症反应的影响  

Effect of leukocyte-depleted intraoperative salvaged blood on erytllrocyte immunity and systemic inflammatory response during perioperative period

作　　者：芶大明[1] 蔡回钧[1] 刘富兵[1] 

机构地区：[1]遵义医学院麻醉学系,563003

出　　处：《中华麻醉学杂志》2011年第5期580-582,共3页Chinese Journal of Anesthesiology

基　　金：贵州省优秀科技教育人才省长基金（2005240-5）;贵州省遵义市15851人才工程支助项目

摘　　要：目的 评价滤除白细胞自体回收血对围术期患者红细胞免疫功能及全身炎症反应的影响。方法选择术中行回收式自体输血患者20例，年龄20～44岁，体重40～75奴，AsA分级Ⅰ或Ⅱ级，预计失血量15—20ml／kg，采用随机数字表法，将患者随机分为两组（n=10）：对照组（C组）和滤除白细胞组（D组）。c组进行常规自体血回收回输，D组自体血滤除白细胞后再输给患者。两组患者分别于麻醉前（T1）、术毕（T2）、术后12h（T1）、36h（T4）时采集中心静脉血标本，采用改良郭峰法检测红细胞C3b受体花环率、红细胞免疫复合物花环率，并行白细胞及中性粒细胞计数；ELISA法检测血浆TNF-α、IL-6、MDA浓度。结果与C组比较，D组T2-6。时血浆IL-6、TNF—n、MDA浓度降低，T3,4时红细胞C3b受体花环率升高（P〈0．01），Td时中性粒细胞计数降低（P〈0．05）。结论滤除白细胞自体回收血有助于改善围术期患者红细胞免疫功能，其机制可能与降低全身炎症反应有关。Objective To investigate the effect of leukocyte-depleted intraoporative salvaged blood on the erythrocyte immunity and systemic inflammatory response during the perioperative period in patients. Methods Twenty ASA I or Ⅱ patients, aged 20-44 yr, weighing 40-75 kg, required blood salvage during operations （intraoperative blood loss expected 15-20 ml/kg）, were randomly divided into 2 groups （ n = 10 each） ： control group （group C） and leukocyte depletion group （group D）. Anesthesia was induced with midazolam, fentanyl, propofol and vecuronium and maintained with isoflurane inhalation and iv infusion of propofol and remifentanil. The patients were mechanically ventilated after tracheal intubation. Intraoperative blood salvage and reinfusion were performed in all patients using cell saver system. In group D, the salvaged blood was filtered with a leukocyte depleting filter placed in the line of the reinfusion circuit. Blood samples were collected from the central vein before anesthesia （T1）, at the end of surgery （T2 ）, and at 12 h （T3 ） and 36 h （T4） after operation in the two groups. The rosette rates of RBC-C3b receptors and RBC-immune complex were determined. The leukocyte and neutropbil were counted. The plasma levels of interleukin-6 （IL-6）, tumor necrosis factor-alpha （TNF-α） and malondialdehyde （MDA） were measured. Results The plasma levels of IL-6, TNF-α and MDA were significantly lower at T2-4, the rosette rate of RBC-C3b receptors was significantly higher at T3-4 （ P 〈 0.01）, and the neutrophil count was significantly lower at T4 in group D than in group C （ P 〈 0.05 ）. Conclusion Leukocyte-depleted intraoperative salvaged blood is helpful to improve the erythrocyte immunity during the perioperative period in patients, and the decrease in the systemic inflammatory response may be involved in the mechanism.

关 键 词：白细胞去除术 输血 自体 免疫 细胞 红细胞 炎症 

分 类 号：R457[医药卫生—治疗学]