急性等容量血液稀释对老年手术患者术后肺部感染的影响  

Effect of acute normovolemic hemodilution on posteroperative pulmonary infections in the aged undergoing operations

作　　者：刘志军[1] 李国政[1] 姜云峰[1] 

机构地区：[1]浙江省立同德医院麻醉科,浙江杭州310013

出　　处：《中华医院感染学杂志》2014年第3期674-675,678,共3页Chinese Journal of Nosocomiology

基　　金：浙江省卫生厅基金资助项目(2012KYB046)

摘　　要：目的观察急性等容量血液稀释（ANH）对老年患者术后肺部感染以及围术期细胞免疫功能的影响，以探讨其临床应用安全性。方法将70例ASAⅠ-Ⅱ级的择期食管癌根治术老年患者，依据随机数字表法分为ANH组与对照组，每组各35例，分别于ANH前（T1）、ANH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，数据采用SPSS13．0统计软件分析处理。结果ANH前两组患者一般资料比较差异无统计学意义；ANH组T2、T3时间点的CD3＋细胞水平分别为（61．6±3．7）％、（59．8±3．2）％、CD4＋分别为（37．6±5．0）％、（36．4±3．8）％，均高于对照组，差异有统计学意义（P〈0．05）；T4、T5时间点的CD3＋细胞水平分别为（60．2±3．6）％、（62．1±4．4）％、CD4＋分别为（36．8±4．2）％、（37．5±4．9）％，两组比较差异均无统计学意义；ANH组的术后感染率（7．1％）低于对照组（11．4％），差异无统计学意义。结论术前采用6％羟乙基淀粉液130／0．4进行ANH一定程度上可以促进T淋巴细胞水平的恢复，从而改善患者围术期的免疫抑制状态，有利于降低术后肺部感染危险性。OBJECTIVE To investigate the effects of acute normovolemic hemodilution （ANH） perioperative immune functions and postoperative infection in the aged undergoing esophageal resection, so as to discuss the safety of its clinical application. METHODS A total of 70 cases of ASA Ⅰ-ⅡI elderly patients undergoing elective esophageal resection were enrolled in the study. The patients were divided into two groups based on random number table, including the ANH group（n= 35） and the control group（n= 35）. The venous blood samples were takenbefore（T1） and immediately（T2） after the ANH, and immediately（T3）, 24h（T4） and 7d（TS） after operation to measure the subsets of T lymphocyte （CD3＋, CD4＋, CD8＋） with flow cytometry, and the total incidence rate of postoperative infection within 7 days was counted, analyzed by SPSS13.0 software. RESULTS There was no significant difference between two groups before ANH. The serum levels of CD3＋ （T2： 61. 6 ±3.7%; T3： 59.8±3.2%）, CD4＋（T2： 37. 6±5.0%; T3： 36.4±3. 8%） T lymphocyte were higher in the ANH group than the control group at T2, T3, and the difference was significant （P〈0. 05）. There was no significant difference in the subsets of CD3 ＋ （T4 ： 60. 2± 3.6 % ; T5 ： 62. 1 ±4. 4 %）, CD4 ＋ （T4 ： 36. 8 ± 4.2% ; T5：37.5 ± 4. 9%）T lymphocyte at T4, T5 between two groups. The incidence of postoperative infection was lower in the ANH group（7. 1%） than the control group（11.4%）, but there was no difference. CONCLUSION ANH with 6% hydroxyethyl starch 130/0. 4 may promote T lymphocyte recovery to mitigate perioperative immune suppress, to help to improve the immunosuppression station in postoperative period and reduce the risk of pulmonary infections.

关 键 词：急性等容量血液稀释 免疫功能 肺部感染 食管癌根治术 

分 类 号：R563[医药卫生—呼吸系统]