急性等容血液稀释联合自体血回输对异位妊娠手术患者免疫功能及预后的影响  

Influence of acute normovolemic hemodilution combined with autologous blood transfusion on immune function and prognosis in surgical patients with ectopic pregnancy

作　　者：孙楠[1] 温转[1] 程建欣 

机构地区：[1]河北医科大学第四医院输血科,河北石家庄050011 [2]河北医科大学第四医院妇产科,河北石家庄050011

出　　处：《中国输血杂志》2016年第10期1150-1153,共4页Chinese Journal of Blood Transfusion

摘　　要：目的探讨急性等容血液稀释(ANH)联合回收式自体输血对异位妊娠手术患者免疫及预后的影响。方法选择2011年10月-2016年8月河北医科大学第四医院妇产科128名,根据自愿原则分为自体(输血)组:72名以ANH联合自体血回输的异位妊娠手术患者;异体(输血)组:56名拟行异体血输注的同类患者。记录2组患者失血量及输血量,测定术前、术后3及10 d T细胞亚群(CD3^+、CD4^+、CD8^+)与NK细胞含量以及IgG、IgM和补体C3水平。观察自体组血液采集及回输过程中不良反应及2组患者术后康复情况。结果 1)异位妊娠手术患者失血量(m L/人):1 320±410(自体组)vs 1 290±390(异体组)(P>0.05);自体组术前采集自体血(426±68)m L/人、术中回收血(538±136)m L/人,异体血输注率18.05%(13/72)、平均输血量(632±230)m L/人[异体组相应为100%(56/56)与(1 068±316)m L(P<0.05)];2)自体组术后3、10 d CD3^+、CD4^+、CD8^+、NK细胞含量以及IgG、IgM、C3水平明显优于异体组(P<0.05)。3)自体组自体血采集及回输过程中均未发生严重不良反应,术后肠道排气时间(d)1.41±0.37(自体组)vs 1.78±0.40(异体组)、切口拆线时间(d)5.4±1.9(自体组)vs 6.0±2.3(异体组)及住院时间(d)5.8±2.6(自体组)vs 7.3±2.9(异体组)(P<0.05)。结论 ANH联合自体血回输对异位妊娠手术患者免疫功能的影响较小,有利于患者的术后康复。Objective To explore the influence of acute normovolemic hemodilution combined with autologous blood transfusion on immune function and prognosis in surgical patients with ectopic pregnancy. Methods Acute normovolemic hemodilntion combined with autologous blood transfusion were implemented in 72 cases of surgical patients with ectopic pregnancy from Department of Obstetrics and Gynecology, Third Hospital of Hebei Medical University between October 2011 and August 2016, which were chosen as autologous blood transfusion group, and 56 cases were chosen as allogeneic blood trans- fusion group under the premise of volunteerism. The amounts of blood loss and blood transfusion in two groups were recor- ded. The contents of T cell subgroups （ CD3＋ , CD4＋ , CD8＋ ）, NK cells and levels of IgG, IgM, complement C3 were detec- ~d preoperatively and three and ten days postoperatively. The adverse reactions in the process of autologous blood collection and transfusion were observed. The situations of postoperative recovery were investigated in two groups. Results 1 ） The blood loss volumes showed no statistical differences [ （ 1 320 ± 410） mLvs （1 290±390）mL] （P〉O. 05） in two groups. The preoperative preexisting blood volume was （426 ± 68） ml, the intraoperative blood collection was （538 ±136）mL in autologous blood transfusion group. The cases and volume of banked blood infusion in autologous blood transfusion group were lower than those in allogeneic blood transfusion group （ P 〈 0.05 ）. 2） Compared with allogeneic blood transfusion group, the contents of T cell subgroups （ CD3^＋ , CD^＋ , CD8^＋ ）, NK cells and levels of IgG, IgM, complement C3 at postoperative 3 d and 10 d in autololgous blood transfusion group displayed significant differences （ P 〈 0. 05 ）. 3 ） No serious adverse reactions occurred in the process of autologous blood collection and transfusion in autologous blood transfusion group, the intestinal exhaust time（d） 1.41 ±0. 37 vs 1.78 -0. 40 ,

关 键 词：急性等容血液稀释 回收式自体输血 异位妊娠 手术 免疫 预后 

分 类 号：R457.1[医药卫生—治疗学] R713.8[医药卫生—临床医学]