术中自体血液回收对回收红细胞氧解离曲线和2，3-二磷酸甘油酸的影响  

Effects of intraoperative cell salvage on oxygen dissociation curve and 2,3-disphosphoglycerate of salvaged red blood cells

作　　者：李修良[1] 董鹏[1] 张晔[1] 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,100050

出　　处：《国际麻醉学与复苏杂志》2016年第8期700-704,共5页International Journal of Anesthesiology and Resuscitation

基　　金：首都医学发展基金（2007-1039）;北京自然科学基金（7122050）

摘　　要：目的评价自体血液回收对回收红细胞氧解离曲线和2,3-二磷酸甘油酸（2,3-diphosphoglycerate, 2,3-DPG）的影响。方法选择15例择期行非体外循环冠状动脉旁路移植术的患者。使用自体血液回收机收集和洗涤术中回收血液。测定和比较自体静脉血红细胞（时间点T1）和回收红细胞在回收即刻（时间点T2）、室温（21～24℃）贮存4h（时间点L）和低温（1-6℃）贮存24h（时间点T4）的氧解离曲线（％值，氧饱和度为50％时的氧分压值）和2，3-DPG的浓度。每个时间点皆采取1个血液样本用于检测上述指标并且根据时间点把所有血液样本分为4组（T1组、T2组、T3组和T4组）。结果T2组、T3组和T4组的氏值分别为（28．77±0．27）、（28．94±0．25）和（28．87±0．34）mmHg（1mmHg=0．133kPa），都显著高于T1组的P钔值[（27．07±0．23）mmHg]，差异有统计学意义（R0．05）；和T2组比较，L组和T4组的P50值都没有明显变化（P〉0．05）。T2组的2，3-DPG浓度[（18±7）μmol／g]明显高于T1组[（13±6）μmol／g]，差异有统计学意义（P〈0．05）；L组和T4组的2,3-DPG浓度分别为（15±12）μmol／g和（15±6）μmol／g，和T1组比较有所升高，但差异无统计学意义（P〉0．05）；T3组和T4组的2,3-DPG浓度和R组比较，有所降低，但差异无统计学意义（P〉0．05）。结论回收红细胞的氧运载能力并没有受到自体血液回收技术的影响，回收红细胞即刻的氧运载能力优于患者自身静脉血红细胞，而且贮存在21-24℃4h和1-6℃24h并没有明显变化。Objective To assess effects of intraoperative cell salvage on oxygen carrying capacity of salvaged red blood cells （RBCs） during cardiac surgery. Methods Fifteen patients undergoing off-pump coronary artery bypass grafting surgery were enrolled. Blood was collected and processed using a Dideco Electa device. The level of Ps0 and 2,3-diphosphoglycerate （2, 3-DPG） from venous RBCs （time Ti） and salvaged RBCs （time T2） was measured. We also measured the changes of these indicators among salvaged RBCs at 4 h（storage at 21-24℃, time T3） and at 24 h（storage at 1-6℃, time T4）. Oneblood sample was taken at each time point and all blood samples were divided into four groups （T1 group, T： group, T3 group and T4 group according to the time point）. Results The P50 value of T2 group[（28.77±0.27） mmHg]（1 mmHg=0.133 kPa）, T3 group [（28.94±0.25） mmHg] and T4 group[（28.87±0.34） mmHg] was significantly higher than the value of T1 group [（27.07±0.23） mmHg]（P〈0.05）.The Psovalueof T3 group and T4 group did not change obviously compared with the value of T2 group （P〉0.05）. The 2, 3-DPG value of T2 group [ （18±7） μmol/g]was significantly higher than the value of T1 group [（13±6）μmol/g] （P〈0.05）. The level of 2, 3-DPG of T3 group [（15±12）μmol/g] and T4group [（15±6）μmol/g] slightly increased compared with the value of T1 group （P〉0.05）. The level of 2,3- DPG of T3 group and T4 group slightly decreased compared with the value of T2 group （P〉0.05）. Conclusions The oxygen transport function of salvaged RBCs at 0 h was not influenced by the cell salvage process and was better than that of the venous RBCs. At the end of storage, the oxygen transport function of salvaged RBCs did not change consequently.

关 键 词：术中自体血液回收 氧解离曲线 2 3-二磷酸甘油酸 

分 类 号：R614[医药卫生—麻醉学]