自体血液回输对脊椎手术患者围术期血浆ICAM-1和炎症介质的影响  

Effect of Autologous Blood Transfusion on Plasma ICAM-1 and Inflammatory Mediators During Perioperative Period in Patients Undergoing Spine Surgery

作　　者：杨靖[1] 潘道波[2] 陈安基[2] 

机构地区：[1]徐州医学院麻醉学院08级研究生,江苏徐州221002 [2]湖南省常德市第一人民医院麻醉科,湖南常德415000

出　　处：《医学临床研究》2012年第5期861-863,共3页Journal of Clinical Research

摘　　要：[目的]观察自体血液回输对脊椎手术患者围手术期血浆ICAM-1和炎性介质的影响.[方法]60例择期行脊柱外科手术患者随机分为对照组（C组,n=30）与自体血液回输组（H组,n=30）,H组采用标准回收模式,应用血液回收机对回收血进行处理,术中回输给患者.当C组血细胞比容（HCT）〈0.25时则输异体红细胞悬液,出血量〉1500 mL时补输新鲜冰冻血浆（输入血浆总量占出血量30%）,必要时输入冷沉淀.分别于入室前30 min（T1）,初次输注自体或异体血后10 min（T2）,手术结束时（T3）,术后24 h （T4）取肘正中静脉采血2 mL,高速离心后于-70℃液氮低温标记储存待检.分别检测4个时间点血液中细胞间粘附分子-1（ICAM-1）以及肿瘤坏死因子-α（TNF-α）、白介素-1（IL-1）、白介素-8（IL-8）的水平.[结果]与C组比较H组在T3时IL-1、IL-8、ICAM-1浓度明显高于C组（P＜0.05）,术后24 h（T4）,两组上述炎症细胞因子无明显差异（P〉0.05）.[结论]自体血液回收回输能引起血液中炎性因子的激活,但并不导致血管内皮细胞大量受损,激活严重的全身炎症反应综合征造成明显的组织损伤.[Objective]To observe the effect of autologous blood transfusion on plasma ICAM-1 and in-flammatory mediators during perioperative period in patients undergoing spine surgery. [Methods]Sixty pa-tients scheduled for spine surgery were randomly divided into control group（group C, n = 30） and autologous blood transfusion group（group H, n =30）. Group H received standard blood recovery mode, which the re-trieved blood was dealt with blood recovery machine and then transfused into the patients. When the hemato-erit（HCT） in group C was lower than 0.25, allogenous red cell suspension was transfused. When the blood loss was more than 1500mL, fresh frozen plasma was additionally transfused（the total transfused plasma vol-ume occupied 30% of total bleeding volume）. If necessary, cryoprecipitate was transfused. Blood 20ml in me- dian vein of elbow at 30min before operation（T1 ）, 10min after the initial infusion of autologous or allogenie blood（T2 ）, the end of the operation（T3 ） and 24h after operation（T4 ） was collected for high speed centrifuga-tion and then stored with label at -70℃ in liquid nitrogen refrigerator. The levels of ICAMq, TNF-α, IL-1 and IL-8 in blood at 4 time points were detected respectively. [Results] The levels of IL-1, IL-8 and ICAM-1 in group H at T3 were obviously higher than those in group C（ P〈0.05）. At 24h after operation（T4）, there was no obvious difference in above inflammatory eytokines between two groups（ P〉0.05）. [Conclusion] Au-tologous blood recovery and transfusion can cause the activation of inflammatory factors in blood, but does not cause the massive damage of vascular endothelial cells and obvious tissue damage by the activation of serious systemic inflammatory response syndrome.

关 键 词：胸椎/外科学 腰椎/外科学 输血 自体 内皮 血管/细胞学 脓毒症综合征 

分 类 号：R687.3[医药卫生—骨科学]