急性非等容量血液稀释对妇科肿瘤手术患者围术期免疫功能与术后感染的影响  

Effect of acute non-isovolemic hemodilution on perioperative immune function and postoperative infections in patients with gynecology tumor operations

作　　者：吴林飞 吴艳琴[2] 董小秋 

机构地区：[1]温州市鹿城区人民医院麻醉科,浙江温州325000 [2]温州市第三人民医院麻醉科,浙江温州325000

出　　处：《中华医院感染学杂志》2013年第6期1377-1379,共3页Chinese Journal of Nosocomiology

摘　　要：目的研究急性非等容量血液稀释(ANIH)对妇科肿瘤手术患者围术期细胞免疫功能以及术后感染的影响,以探讨临床应用ANIH的安全性。方法依据随机数字表法将30例ASAⅠ～Ⅱ级的择期妇科手术患者随机分为ANIH组与对照组,每组各15例,ANIN组采用6%羟乙基淀粉液行急性非等容量血液稀释,对照组采用常规补充输液量;分别于ANIH前(T1)、ANIH后(T2)、术毕即刻(T3)和术后1d(T4)、7d(T5)用流式细胞术测定血清T淋巴细胞亚群(CD3+、CD4+、CD8+)水平,并统计术后7d的感染率。结果两组在T1时间点的CD3+、CD4+、CD8+细胞水平间的差异无统计学意义;AHH组T2、T3时间点的CD3+[T2(60.6±3.7)%;T3(58.8±3.1)%]、CD4+[T2(37.2±5.0)%;T3(36.4±3.8)%]细胞水平均高于对照组,差异有统计学意义(P<0.05);两组T4、T5时间点的CD3+[T4(59.2±3.4)%;T5(61.2±4.3)%]、CD4+[T4(36.8±4.2)%;T5(37.5±4.9)%]细胞水平之间差异均无统计学意义;术后7d内30例患者中有7例并发感染,其中,ANIH组3例,感染率为20.0%;对照组4例,感染率为26.7%,ANIH组的术后感染率低于对照组,但两组差异无统计学意义。结论术前采用6%羟乙基淀粉液进行ANIH可以改善患者围术期的免疫抑制状态,有利于降低术后感染危险性。OBJECTIVE To investigate the effect of acute non-isovolemic hemodilution on perioperative immune function and postoperative infections in the patients undergoing gynecology tumor operation so as to explore the clinical security of ANIH. METHODS Thirty ASA I-II patients aged between 45 and 60 years undergoing elective gynecology tumor surgery were enrolled in the study. The patients were divided randomly into two groups, including the ANIH group（n=15） and the control group（n= 15） the ANIH sroup was treate with 6% hydroxyethyl starch; for the acute hemodilution, while the control group was treated with routine complement infusion volume. The venous blood samples were taken before（T1） and immediately（T2） after the hemodilution, and immediately（T3）, 24h（T4） and 7d（T5） after operation to measure the subsets of T lymphocyte （CD3＋, CD4 ＋ , CD8 ＋） with flow cytometry, and the total incidence of postoperative infections within 7 days was counted. RESULTS There was no significant difference in the subsets of T lymphocyte （CD3 ＋ , CD4 ＋ , CD8 ＋ ） at T1 between the two groups; the serum levels of CD3＋ [T2（60.6±3.7）% ; T3（58.8±3. 1） %], CD4＋ [T2（37.2± 5.0）%; T3（36.4±3. 8）%] T lymphocyte were higher in the ANIH group than the control group at T2, T3. There was no significant difference in the subsets of CD3 ＋ [T4 （59.2 ± 3.4）%; T5 （61. 2 ± 4. 3）%], CD4 ＋ [T4 （36.8 ± 4.2） % ; T5 （37.5 ± 4.9）% ] T lymphocyte at T4, T5 between the two groups. There were 7 of 30 cases of patients complicated with postoperative infections within 7 days, among which there were 3 cases in the ANIH group with the infection rate of 20.0% and 4 cases in the control with the infection rate of 26.7%, the incidence of the postoperative infections in the ANIH group was lower than that in the control group, the difference was not statistically significant. CONCLUSION ANIH with 6 % hydroxyethyl starch may improve the perioperative immune suppress, which can help

关 键 词：急性非等容量血液稀释 免疫功能 术后感染 妇科手术 

分 类 号：R181.32[医药卫生—流行病学]