经白细胞滤器过滤后的体外循环机血回输对心脏手术患者细胞免疫功能的影响  

Effects of reinfusion of the remaining blood filtered by leukocyte depletion filter on postoperative cellar immune function after cardiopulmonary bypass

作　　者：罗琳[1] 王丹[1] 陈梅珠[1] 李美霞[1] Luo Lin;Wang Dan;Chen Meizhu;Li Meixia(Department of Anesthesiology,Haikou Municipal Hospital,Central South University Xiangya School of Medicine Affiliated Haikou Hospital,Haikou 570208,Hainan,China)

机构地区：[1]海口市人民医院暨中南大学湘雅医学院附属海口医院麻醉科,570208

出　　处：《中华危重病急救医学》2019年第8期989-993,共5页Chinese Critical Care Medicine

基　　金：海南省自然科学基金(2017817385).

摘　　要：目的评估经白细胞滤器过滤后的体外循环机血回输对心脏手术患者细胞免疫功能的影响。方法选择2018年1月至6月海口市人民医院麻醉科收治的预计不需要输注异体血的40例心脏瓣膜置换术患者,按随机数字表法分为对照组和试验组,每组20例。试验组在体外循环(CPB)结束后即刻将CPB剩余机血用白细胞滤器过滤并存储于无菌储血袋中,对照组将剩余机血直接储存于无菌储血袋中,两组均于CPB停机后回输CPB剩余机血。分别于患者术前(T1)、CPB后2 h(T2)及回输机血后1、3、5 d(T3、T4、T5)取颈内静脉血,采用流式细胞仪检测全血T淋巴细胞亚群CD3^+、CD4^+、CD8^+和自然杀伤细胞(NK细胞)的数量,计算CD4^+/CD8^+比值;采用酶联免疫吸附试验(ELISA)测定血浆肿瘤坏死因子-α(TNF-α)、白细胞介素(IL-2、IL-6、IL-8)水平。并比较两组术后机械通气时间、重症加强治疗病房(ICU)住院时间、总住院时间、术后伤口感染发生率和肺感染发生率。结果40例患者中男性22例,女性18例;年龄(47.88±12.29)岁;美国麻醉医师协会健康状态分级(ASA分级)Ⅱ级25例,Ⅲ级15例。试验组和对照组剩余机血回输量比较差异无统计意义(mL:959.00±116.84比971.50±115.68,P>0.05)。与T1比较,两组于T2时起血中CD3^+、CD4^+、CD8^+、NK细胞水平及血浆IL-2水平即明显降低,T3时起CD4+/CD8+比值即明显降低,但两组间各时间点血中CD3^+、CD4^+、CD8^+、NK细胞水平、CD4^+/CD8^+比值以及血浆IL-2水平比较差异无统计学意义。与T1比较,两组T2时TNF-α、IL-6、IL-8水平明显升高,随后逐渐下降。试验组T3起TNF-α、IL-6、IL-8水平即明显低于对照组〔TNF-α(ng/L):28.49±4.66比33.82±4.30,IL-6(ng/L):25.98±4.51比31.38±5.42,IL-8(ng/L):38.98±4.67比45.76±5.33,均P<0.05〕,并于T5时已恢复至T1时水平。此外,试验组术后机械通气时间、ICU住院时间较对照组明显缩短(h:8.07±1.30比9.16±1.52,28.22±2.78比3Objective To evaluate effects of reinfusion of the remaining blood filtered by leukocyte depletion filter on postoperative cellular immune function after cardiopulmonary bypass(CPB).Methods Forty patients who underwent selective cardiac valve replacement surgery with CPB in department of anesthesiology of Haikou Municipal Hospital from January to June in 2018 were enrolled.All the patients were divided into the control group and experimental group according to the random number table method,with 20 patients in each group.In the experimental group,patients received residual pump blood transfusion which had been filtered by leukocyte depletion filter and stored in sterile blood collection bags.In the control group,patients received residual pump blood transfusion which was stored in sterile blood collection bags without being filtered.The remaining blood was reinfused after CPB in two groups.Blood samples were taken before CPB(T1),2 hours following CPB(T2),and 1,3,5 days after reinfusion of the remaining blood(T3,T4,T5),the levels of T lymphocyte subsets CD3^+,CD4^+,CD8^+and natural killer cells(NK cells)were detected by flow cytometer,and CD4^+/CD8^+ratio was calculated.The levels of plasma tumor necrosis factor-α(TNF-α),interleukins(IL-2,IL-6,IL-8)were measured by enzyme linked immunosorbent essay(ELISA).The duration of mechanical ventilation,the length of intensive care unit(ICU)stay,the length of hospital stay,and incidence of wound and pulmonary infection after surgery were compared between two groups.Results Among 40 patients,there were 22 males and 18 females;with an age of(47.88±12.29)years old;and with 25 cases of American Society of Anesthesiologists(ASA)physical statusⅡ,and 15 cases of ASAⅢ.There was no statistical difference in the volume of the remaining blood between the two groups(mL:959.00±116.84 vs.971.50±115.68,P>0.05).Compared with T1,the levels of T lymphocyte subsets CD3^+,CD4^+,CD8^+,NK cells and plasma levels of IL-2 were significantly decreased from T2,the CD4^+/CD8^+ratio was signi

关 键 词：白细胞滤器 体外循环 剩余机血 细胞免疫 全身炎症反应 

分 类 号：R654.2[医药卫生—外科学]