异体红细胞输注对胸腰椎手术术后感染影响的研究  

Effect of allogeneic red blood cell transfusion on postoperative infection of thoracolumbar surgery patients

作　　者：蒋中艳[1] 刘龙娣[1] 王翀[1] 孔维军[1] 王安素[1] JIANG Zhong-yan;LIU Long-di;WANG Chong;KONG Wei-jun;WANG An-su(Affiliated Hospital of Zunyi Medical College of Guizhou,Zunyi,Guizhou 563000,China)

机构地区：[1]贵州省遵义医学院附属医院脊柱外科

出　　处：《中华医院感染学杂志》2019年第15期2339-2342,2352,共5页Chinese Journal of Nosocomiology

基　　金：国家自然科学基金资助项目(86623242);贵州省科技厅联合基金资助项目(黔科合LH字[2015]7491号)

摘　　要：目的探讨异体红细胞输注对胸腰椎手术患者感染的影响。方法选取贵州省遵义医学院附属医院2016年2月-2018年7月158例行脊柱手术患者为研究对象,根据是否进行异体红细胞输注分为异体红细胞输注组(n=70)和非异体红细胞输注组(n=88)。统计患者一般临床资料和术后医院感染发生率,对于术后感染患者检测病原菌;术前、术后1 d和术后7 d,采集患者静脉血5 ml,检测CD3^+、CD4^+、CD8^+,并计算CD4^+/CD8^+。结果异体红细胞输注组共15例发生术后感染,感染发生率为21.43%,非异体红细胞输注组共4例发生术后感染,术后感染发生率为4.55%,异体红细胞输注组感染发生率高于非异体红细胞输注组(P<0.05);19例术后感染患者共分离得到22株病原菌,其中革兰阴性菌14株占63.64%,革兰阳性菌8株占36.36%,未见真菌;术后1 d和术后7 d,异体红细胞输注组CD3^+、CD4^+和CD4^+/CD8^+均低于非异体红细胞输注组(P<0.05);CD8^+均高于非异体红细胞输注组(P<0.05);Logistic回归分析结果显示,异体红细胞输注、术中出血量和使用抗菌药物是脊柱手术患者术后发生感染的独立影响因素(P<0.05)。结论胸腰椎手术患者进行异体红细胞输注会抑制T淋巴细胞功能,影响自身免疫功能,增加术后感染发生率,临床上应该加以重视。OBJECTIVE To investigate the effect of allogeneic red blood cell transfusion on infection in patients undergoing thoracolumbar surgery.METHODS A total of 158 patients with spinal surgery in the hospital from Feb.2016 to Jul.2018 were selected.The patients were divided into allogeneic red blood cell infusion group(n=70)and non-heterologous red blood cell infusion group according to whether or not allogeneic red blood cell transfusion was performed(n=88).The general clinical data of the patients and the incidence of postoperative nosocomial infection were statistically analyzed.The pathogens were examined for patients with postoperative infection.Five ml of venous blood was collected from the patients before surgery and 1 day and 7 days after surgery,and CD3^+,CD4^+,and CD8^+were detected and CD4^+/CD8^+were calculated.RESULTS Postoperative infection occurred in 15 cases of the allogeneic red blood cell transfusion group.Postoperative infection occurred in 4 cases of the non-heterologous red blood cell transfusion group.The postoperative infection rates were 21.43%and 4.55%,respectively(P<0.05).Twenty-two strains of pathogens were isolated from 19 patients with postoperative infection,of which 14 strains of Gram-negative bacteria accounted for 63.64%,and 8 strains of Gram-positive bacteria accounted for 36.36%.No fungi were found.1 day after surgery and 7 days after surgery,the CD3^+,CD4^+and CD4^+/CD8^+of allogeneic red blood cells in the infusion group were significantly lower than those in the non-heterologous red blood cell transfusion group(P<0.05).CD8^+was significantly higher than that of the non-heterologous red blood cell infusion group(P<0.05).Logistic regression analysis showed that allogeneic red blood cell transfusion,intraoperative blood loss and antibiotic use were independent factors influencing postoperative infection in patients undergoing spinal surgery(P<0.05).CONCLUSION Allogeneic red blood cell transfusion in patients with thoracolumbar surgery can inhibit T lymphocyte function,affect autoimmu

关 键 词：胸腰椎 手术 异体红细胞 输血 感染 T淋巴细胞 

分 类 号：R619[医药卫生—外科学]