洗涤式自体血回输对糖尿病患者回收血红细胞渗透脆性的影响  

Effects of washed autologous blood transfusion on erythrocytic fragility in salvaged blood fromdiabetics

作　　者：林慧丹[1] 张冯江[1] 潘志浩[2] 陈小非[2] 郁丽娜[1] 严敏[1] 

机构地区：[1]浙江大学附属第二医院麻醉科,杭州310052 [2]宁波市医疗中心李惠利医院麻醉科

出　　处：《中华医学杂志》2014年第7期491-494,共4页National Medical Journal of China

摘　　要：目的观察洗涤式自体血回输对行非体外冠状动脉旁路移植术（OP-CABG）的糖尿病患者红细胞渗透脆性的影响。方法2011年9月至2012年12月宁波市医疗中心李惠利医院麻醉科择期在洗涤式自体血回输下行OP．CABG的患者60例，根据患者有无糖尿病分为对照组（C组，n=30）和糖尿病组（D组，n=30）。比较红细胞回收率、术前及洗涤前后红细胞溶血率和回收血静置0、4、6、12、24h后的游离血红蛋白和血钾水平。结果两组患者红细胞回收率比较差异无统计学意义（c组82．6％±5．6％，D组80．9％±6．2％，P〉0．05）；同一处理条件下，D组患者术前、洗涤前溶血率在0．36％一0．68％低渗NaCl浓度溶液中均高于C组（术前0．36％：D组84．9％±6．7％C组78．7％±4．6％，P=0．003；术前0．68％：D组9．O％±4．5％C组1．9％±0．8％，P=0．000；洗涤前0．36％：D组80．6％±4．9％C组78．0％±5．8％，P=0．000；洗涤前0．68％：D组11．0％±3．4％c组2．4％±0．9％，P=0．000），洗涤后差异无统计学意义；洗涤后血液随静置时间延长，两组患者游离血红蛋白和血钾浓度均逐渐升高，与洗涤后0h比较差异均有统计学意义（均P〈0．05），但在同一洗涤时间点，上述指标在两组之间差异无统计学意义。结论洗涤式自体血回输并未额外加重行OP-CABG的糖尿病患者红细胞损伤；回收血液洗涤后应尽早输回患者体内。Objective To explore the effects of washed autologous blood transfusion on the recovery and hemolysis of erythrocytes from diabetic patients subjected to off-pump coronary artery bypass grafting （OP-CABG）. Methods A total of Sixty patients were included in this study. The patients were assigned as two groups ： control （ C, n = 30） , and diabetic group （ D, n = 30）. Samples were taken from preoperation, prior to and after disposal of centrifuging and washing to determine the recovery and fragility of erythrocytes. Free hemoglobin and extracellular potassium were measured at 0, 4, 6, 12, 24 h after washing. Results The erythrocytic recovery did not have significant difference between two groups （ C group 82. 6% ± 5.6%, D group 80. 9% ± 6. 2% ,P 〉 0. 05 ）. Under the same processing, the erythrocyte fragility in the diabetic group were significantly higher than the control group in preoperation and beforewashing （ Preoperation 0. 36% ： D group 84. 9% ＋ 6. 7% C group 78. 7% ~ 4. 6% ,P =0. 003 ;Preoperation 0. 68% ：D group 9. 0% ± 4. 5% C group I. 9% ± 0. 8%, P = 0. 000 ; Beforewashing 0. 36% ： D group 80. 6% ± 4. 9% C group 78.0% ± 5.8% ,P = O. 000 ; Beforewashing 0. 68% ： D group 11.0% ± 3.4% C group 2.4% ± 0. 9%, P = 0. 000）. However, after washing there were no significant differences of erythrocyte fragility between groups. Free hemoglobin and blood potassium at 4, 6, 12, 24 h after washing were significantly increased （P 〈 O. 05 ） in a time-dependent manner in the two groups. But there was no obvious difference in the interior-group at the same time point. Conclusions Antotransfusion has no significant extra damage on erythrocytes from diabetic patitents undergoing OP-CABG, and the salvaged blood should be transfused as soon as possible to reduce hemolysis.

关 键 词：自体 血液回输 糖尿病 渗透脆性 溶血率 

分 类 号：R614[医药卫生—麻醉学]