急性等容稀释性自体输血对剖宫产手术患者免疫功能及细胞因子水平的影响  

Effect of acute normovolemic hemodilution autotransfusion on immune function and cytokines level in patients undergoing cesarean section

作　　者：黄伟 许娜 齐峰 HUANG Wei;XU Na;QI Feng(Department of Blood Transfusion,Yan'an University Affiliated Hospital,Yan'an Shaanxi 716000,China)

机构地区：[1]延安大学附属医院输血科

出　　处：《临床和实验医学杂志》2019年第19期2111-2115,共5页Journal of Clinical and Experimental Medicine

基　　金：陕西省自然科学基金(编号:2015831675J)

摘　　要：目的探讨急性等容稀释性(ANH)自体输血对剖宫产手术患者免疫功能及细胞因子水平的影响。方法回顾性选取延安大学附属医院2015年1月至2019年4月收治的61例剖宫产手术患者作为观察对象,按照输血方式分为观察组32例、对照组29例。观察组采用ANH自体输血,对照组采用异体血输注。比较两组术中失血量、手术时间、尿量、血红蛋白(Hb)、血小板计数(PLT)、血细胞比容(HCT)、T细胞亚群(CD3+、CD4+、CD8+)、肿瘤坏死因子-α(TNF-α)、白介素-6(IL-6)、IL-10及不良反应情况。结果两组手术时间、尿量差异无显著性(P>0.05),观察组术中失血量明显少于对照组(P<0.05);术后24 h,观察组Hb、PLT、HCT水平均明显高于对照组(P<0.05);两组输血前、输血10 min的MAP、HR、SVV水平差异均无显著性(P>0.05);相较于术前,术后24 h,观察组的CD3+、CD4+、CD8+水平无明显变化(P>0.05),而对照组CD3+、CD4+显著降低,CD8+显著升高(P<0.05),且观察组CD3+、CD4+水平明显高于对照组,CD8+明显低于对照组(P<0.05);术后24 h,两组TNF-α、IL-6、IL-10水平均较术前明显升高(P<0.05),但观察组TNF-α、IL-6升高幅度小于对照组,IL-10升高幅度大于对照组(P<0.05)。结论ANH自体输血应用于剖宫产手术患者中对免疫功能无明显影响,不会引起炎症反应,无不良反应,值得推广。Objective To investigate the effect of acute normovolemic hemodilution(ANH)autotransfusion on immune function and cytokine level in patients undergoing cesarean section.Methods 61 caesarean section patients in our hospital from January 2015 to April 2019 were selected as observation objects.According to the blood transfusion method,they were divided into observation group(32 cases)and control group(29 cases).The observation group was treated with ANH autotransfusion and the control group was treated with allogeneic blood transfusion.The blood loss,operation time,urine volume,hemoglobin(Hb),platelet count(PLT),hematocrit(HCT),T cell subpopulation(CD3+,CD4+,CD8+),tumor necrosis factor-α(TNF-α),interleukin-6(IL-6),IL-10,and adverse reactions were compared between the two groups.Results There was no significant difference in operation time and urine volume between the two groups(P>0.05).The blood loss in the observation group was significantly lower than that in the control group(P<0.05).The levels of Hb,PLT and HCT in the observation group were higher than those in the control group 24 hours after operation(P<0.05).There was no significant difference in MAP,HR and SVV levels between the two groups before and 10 min after blood transfusion(P>0.05).Compared with preoperative,there was no significant change in CD3+,CD4+,and CD8+levels in the observation group(P>0.05),but in the control group,CD3+and CD4+were significantly decreased,and CD8+was significantly increased(P<0.05).The levels of CD3+and CD4+in the observation group were significantly higher than those of the control group,and CD8+was significantly lower than the control group(P<0.05).At 24 hours after operation,the levels of TNF-α,IL-6 and IL-10 were significantly higher than those before operation(P<0.05).However,TNF-αand IL-6 in the observation group were significantly lower than those in the control group,and IL-10 was significantly higher than the control group(P<0.05).Conclusion The application of ANH autotransfusion in patients undergoing cesarean s

关 键 词：急性等容稀释性 自体输血 剖宫产 免疫功能 细胞因子 

分 类 号：R73[医药卫生—肿瘤]