贮存式自体成分输血与贮存式自体全血输注对脊柱手术患者细胞免疫功能和血液流变学影响的比较  

Effect of storage autologous blood component transfusion versus storage autologous whole blood transfusion on cellular immune function and hemorheology in patients undergoing spinal surgery

作　　者：王欢[1] 程勇[1] 孙世宇 周循 刘小倩 朱娜娜 夏荣 郭建荣[1] Wang Huan1, Cheng Yong1, Sun Shiyu1, Zhou Xun1, Liu Xiaoqian1, Zhu Nana1, Xia Rong2, Guo Jianrong 1(1.Department of Anesthesiology, Gongli Hospital, Second Military Medical University, Shanghai 200135, China ; 2.Department of Transfusion, Huashan Hospital, Fudan University, Shanghai 200040, China)

机构地区：[1]第二军医大学附属公利医院麻醉科,上海市200135 [2]复旦大学附属华山医院输血科,上海市200040

出　　处：《中华麻醉学杂志》2018年第4期391-394,共4页Chinese Journal of Anesthesiology

基　　金：国家自然科学基金（81671919）;上海市公共卫生重点学科建设项目（15GWZK0501）;上海市卫生和计划生育委员会科研项目（201440456）;上海市浦东新区科技发展基金创新基金（PKJ2012-Y54）;上海市浦东新区卫生系统重点学科群建设项目（PWZxq2017-10）

摘　　要：目的 比较贮存式自体成分输血与贮存式自体全血输注对脊柱手术患者细胞免疫功能和血液流变学的影响.方法 择期行多节段脊柱手术患者40例,性别不限,年龄32 ～ 60岁,ASA分级Ⅰ或Ⅱ级.采用随机数字表法分为2组（n=20）：贮存式自体全血输注组（A组）和贮存式自体成分输血组（B组）.于采血前（T0）、采血后即刻（T1）和术毕（T2）时采集动脉血样,测定红细胞计数（RBC）、Hb、Hct、红细胞聚集指数、红细胞刚性指数;于T0、T2和术后6 d（T3）时采集静脉血样2 ml,抗凝处理后采用流式细胞仪检测T淋巴细胞亚群分布：CD3^＋细胞、CD4^＋细胞和NK细胞百分比,并计算CD4^＋/CD8^＋比值.结果 与T0时比较,T2,3时A组、T2时B组CD3^＋细胞、CD4^＋细胞和NK细胞百分比及CD4^＋/CD8^＋比值降低,2组T1时RBC、Hb、Hct降低,T1.2时红细胞聚集指数、红细胞刚性指数降低（P＜0.05）;与A组比较,B组T3时CD3^＋细胞、CD4^＋细胞和NK细胞百分比及CD4^＋/CD8^＋比值升高（P＜0.05）,各时点RBC、Hb、Hct、红细胞聚集指数、红细胞刚性指数比较差异无统计学意义（P＞0.05）.结论 贮存式自体成分输血对脊柱手术患者免疫功能的影响程度较贮存式自体全血输注减轻,两者对血液流变学的影响无差异.Objective To compare the effect of storage autologous blood component transfusion versus storage autologous whole blood transfusion on the cellular immune function and hemorheology in the patients undergoing spinal surgery.Methods Forty patients of both sexes,aged 32-60 yr,of American Society of Anesthesiologists physical status Ⅰ or Ⅱ,undergoing elective multilevel spinal surgery,were divided into 2 groups （n =20 each） using a random number table：stored autologous whole blood transfusion group （group A） and stored autologous blood component transfusion group （group B）.Before blood sampling （T0）,immediately after blood sampling （T1） and at the end of surgery （T2）,arterial blood samples were collected for determination of red blood cell count （RBC）,hemoglobin （Hb）,hematocrit （Hct）,erythrocyte aggregation index （EAI） and erythrocyte rigidity index （ERI）.Venous blood samples were collected at T0,T2 and on day 6 after surgery （T3）,the distribution of T lymphocyte subsets （percentage of CD3^＋,CD4^＋ and NK cells） was measured,and CD4^＋/CD8^＋ ratio was calculated.Results Compared with the baseline at T0,the percentage of CD3^＋,CD4^＋ and NK cells and CD4^＋/CD8^＋ ratio were significantly decreased at T2,3 in group A and at T2 in group B,and RBC,Hb and Hct were significantly decreased at T1,and EAI and ERI were decreased at T1,2 in two groups （P〈0.05）.Compared with group A,the percentage of CD3^＋,CD4^＋ and NK cells and CD4^＋/CD8^＋ ratio were significantly increased at T3 （P〈0.05）,and no significant change was found in RBC,Hb,Hct,EAI or ERI at each time point in group B （P〉0.05）.Conclusion The effect of storage autologous blood component transfusion on cellular immune function is mitigated than that of storage autologous blood transfusion and the effects on hemorheology are comparable in the patients undergoing spinal surgery.

关 键 词：输血 自体 红细胞 免疫 血液流变学 

分 类 号：R457.1[医药卫生—治疗学]