术中自体回收洗涤红细胞携氧能力评价  

The oxygen carrying and releasing capability of intraoperative cell salvaged RBC

作　　者：董鹏[1] 李修良[1] 车辑[2] 田鸣[1] 

机构地区：[1]首都医科大学附属北京友谊医院麻醉科,北京100050 [2]首都医科大学附属北京安贞医院

出　　处：《中国输血杂志》2016年第3期235-238,共4页Chinese Journal of Blood Transfusion

基　　金：北京自然科学基金(7122050);首都卫生发展科研专项(首发2011-2002-06);首都医科大学附属北京友谊医院科研启动资金(yyqdkt2011-25)

摘　　要：目的评价术中自体回收红细胞的携氧释氧能力。方法共20名年龄18-70岁择期行非停跳冠脉搭桥手术、使用术中血液回收的患者入组本研究。拟合患者开始进行血液洗涤时的静脉血、回收洗涤和贮存悬浮红细胞的氧合血红蛋白解离曲线(OHDC),同时测定红细胞2,3-二磷酸甘油酸(2,3-DPG)含量。OHDC的测定采用标准混合法,2,3-DPG含量测定采用比色法。对比静脉血、自体回收血和贮存悬浮红细胞OHDC的形状、位置、P50值,和2,3-DPG含量。结果血氧饱和度在20%-80%范围内的自体回收红细胞OHDC方程式为Log[SO_2/(1-SO_2)]=-4.1+2.8 Log PO_2(R^2=0.997,P<0.01),静脉血红细胞OHDC方程式为Log[SO_2/(1-SO_2)]=-3.8+2.7 Log PO_2(R^2=0.998,P<0.01),贮存悬浮红细胞OHDC方程式为Log[SO_2/(1-SO_2)]=-2.8+2.4 Log PO_2(R^2=0.973,P<0.01)。回收血红细胞的OHDC较静脉血的OHDC右移,贮存悬浮红细胞的OHDC较静脉血的OHDC左移。回收洗涤红细胞的P50值(28.1±0.4)mm Hg,较静脉血红细胞(26.4±0.2mm)Hg升高(P<0.01),贮存悬浮红细胞P50值(15.8±0.6)mm Hg,明显低于静脉血和回收洗涤红细胞P50值(P<0.01)。回收洗涤红细胞的2,3-DPG含量(6.14±2.40)μmol/g Hb,明显高于静脉血(4.92±2.05)μmol/g Hb(P<0.01);贮存悬浮红细胞的2,3-DPG含量(0.78±0.33)μmol/g Hb,较静脉血和回收洗涤血液明显降低(P<0.01)。结论术中自体回收红细胞保持了同静脉血红细胞相似的携氧释氧功能。贮存10-15 d的悬浮红细胞携氧释氧功能明显降低。Objective To evaluate the oxygen carrying and releasing ability of intraoperative cell salvaged red blood cells （RBCs） by establishing and analyzing the oxyhemoglobin dissociation curve （OHDC） of salvaged RBC. Methods Twenty patients, planned to do cell salvage with Fresenius Continuous AutoTransfusion System device during operation, were recruited. The OHDC of salvaged RBCs, venous RBCs and stored packed red blood cells （PRBCs） in citrate-phosphate-dex- trose-adenine （CPD-A） fluid were traced by standard mixing method. The equations of OHDCs were done according to the curve. 2,3-disphosphoglycerate （2,3-DPG） and theology of the washed RBCs, Venous RBCs and stored PRBCs were meas- ured by colorimetric technique. Results Mean OHDC of the washed RBCs shifted to the right, compared with the venous＇, but the OHDC of stored PRBCs＇ moved to the left significantly. The equations of cell salvage RBCs, venous RBCs and stored PRBCswereLOg[SO2/（1- SO2）] = -4.1＋2.8LogPO2（R^2=0.997,P〈0.01, Log[SO2/（1 - SO2）] = -3.8＋ 2.7 Log PO2 （ R^2 = 0. 998,P 〈 0. 01 ） and Log [ SO2/（ 1 - SO2 ） ] = - 2. 8 ＋ 2.4 Log PO2 （R^2 = 0. 973, P 〈 0. 01 ） respec- tively. The P50 of cell salvaged blood was 28. lmmHg, increased compared with venous RBCs （P 〈0. 01）. There was signif- icant difference about 2,3-DPG between the cell salvaged RBC and preoperative venous blood, P 〈0. 01. The 2,3-DPG of stored RBCs＇ decreased sharply compared with the venous bloods, P 〈 0. 01. Conclusion Cell salvaged RBC exhibited good oxygen carrying and releasing capability, the same as venous RBC. The parameters of stored PRBC were not as good as cell sal- vaged RBC. When the blood transfusion is needed during the operation, the cell salvaged blood is prime for the patients.

关 键 词：自体血液回收 氧合血红蛋白解离曲线 2 3-二磷酸甘油酸 

分 类 号：R457.1[医药卫生—治疗学] R331.141[医药卫生—临床医学]