评估体外循环过程中三种血液回收设备对红细胞功能的影响  

Comparison the effects of three Cell Saver devices on erythrocyte function during cardiopulmonary bypass procedure

作　　者：王小华[1] 吉冰洋[1] 张燕婉[1] 孙燕华[1] 朱贤[1] 刘晋萍[1] 龙村[1] 

机构地区：[1]北京协和医学院阜外心血管病医院体外循环科,北京100037

出　　处：《中国体外循环杂志》2012年第1期16-19,35,共5页Chinese Journal of Extracorporeal Circulation

摘　　要：目的评估三种血液回收设备在体外循环(CPB)回收清洗过程中对红细胞功能的影响。方法将30例CPB的成年患者随机分配3组:C组(Cell Saver 5+;Haemonetics,n=10),M组(Autolog;Medtronic,n=10)和F组(CATS;Fresenius He-moCare,n=10)。分别从回收罐及清洗后的输血袋中采血样。对其进行红细胞聚集指数(AI),变形性指数(DI),红细胞比容(Hct)并校正的全血黏度(HV),2,3-二磷酸甘油酸(2,3-DPG),Hct,血红蛋白(Hb),葡萄糖(Glu),乳酸(Lac),血尿素氮(BUN),游离血红蛋白清除率(△FHB)的比较。结果经血液处理后,AI值在三组之间没有统计学差异(P<0.05)。DI值C组和M组与F比较有相对较高的DI值(P<0.05)。同时M组有最低的HV(P<0.05)。Δ2,3-DPG C组较低,与M组和F组比较有极显著差异(P<0.01)。Hct和Hb F组>C组>M组。C组和M组具有较高ΔFHB,于F组相比均有显著统计学差异(P<0.05)。结论三种血液回收设备具有相同的以离心为基础的工作原理,但基于其设计的不同,对处理过的红细胞功能的影响,以及对有害物质的清除效果在不同的设备之间却有明显的差异。Objective Cell salvage devices are routinely used to process red blood cells （RBCs） shed during cardiac surgery. The purpose of this study was to evaluate three commercially available cell saver （CS） devices in terms of erythrocyte function and the quality of washed RBCs during cardiopulmonary bypass （CPB）. Methods Thirty patients underwent CPB were randomly allocated to three CS devices： Group C （Cell Saver 5 ＋; Haemonetics, n = 10）, Group M （Autolog; Medtronic, n = 10）, and Group F （CATS; Fresenius HemoCare, n = 10）. Blood samples were collected from reservoir and transfusion bag. Reservoir＇s and washed RBCs were analyzed for erythrocyte aggregation index （ AI）, deformation index （ DI ） and hematocrit viscosity （ HV ）, 2, 3 - diphosphoglycerate （2,3- DPG）, hemotacrit （Hct） , hemoglobin （Hb）, free hemoglobin removal （AFHB） , glucose （Gila）, lactate （Lac）, as well as blood urea nitrogen （BUN）. Results After processing, Group C （ P -0.026） and M （ P =0.032） had relatively higher erythro- cyte DI compare with Group F. Group C had lower △2, 3 -DPG comparing with Group M （ P =0.001） and F （ P =0.001）. Group F provided the maximal concentration ofHet （ P =0.021; 0.046） and Hb （ P =0.008; 0.013）. In addition, Group C （ P =0.035） and M （ P =0.038） had the higher removal of FHB （AFHB） and had significant difference comparing with Group F. Conclusion CS devices use the same theory of centrifugation, however based on the different design, the function of the washed erythrocyte and undesirable content removal efficiency differs widely from one device to another.

关 键 词：血液回收机 红细胞功能 体外循环 2 3-二磷酸甘油酸 

分 类 号：R654.1[医药卫生—外科学]