术中血液回收对不停跳冠状动脉旁路移植术术中中性粒细胞胞外诱捕网洗涤效果的评价  

Evaluation of the application of intraoperative blood salvage on neutrophil extracellular traps in off-pump coronary artery bypass graft surgery

作　　者：郑莉[1] 杨鹤[1] 邹毅[1] ZHENG Li;YANG He;ZOU Yi(Department of Anesthesiology,Beijing Friendship Hospital,Capital Medical University,Beijing 100050,China)

机构地区：[1]首都医科大学附属北京友谊医院麻醉科,北京100050

出　　处：《临床和实验医学杂志》2020年第14期1530-1534,共5页Journal of Clinical and Experimental Medicine

基　　金：北京市属医院科研培育基金(编号:PZ2019001);首都医科大学附属北京友谊医院科研启动基金(编号:yyqkkt2015-7)。

摘　　要：目的评价术中血液回收(IBS)对不停跳冠状动脉旁路移植术(OPCABG)术中中性粒细胞胞外诱捕网(NETs)的洗涤效果。方法回顾性选取2017年6~12月于首都医科大学附属北京友谊医院行OPCABG患者20例,均应用IBS。分别取术前外周静脉血(T 0期)、回收自体血(T 1期)和洗涤自体血(T 2期)这三个不同时间点的血浆样本,检测其中NETs成分,包括细胞外DNA、核小体和髓过氧化物酶(MPO)的含量。结果术前外周静脉血(T 0期)中细胞外DNA为25.09(7.26,88.35)ng/ml,MPO为4.64(1.30,7.90)ng/ml,核小体为0.06±0.04;回收自体血(T 1期)中细胞外DNA为4985.59(2949.07,14171.43)ng/ml,MPO为392.33(199.12,755.11)ng/ml,核小体为3.11±0.24;洗涤自体血(T 2期)中细胞外DNA为330.32(197.79,1258.53)ng/ml,MPO为36.79(26.14,65.60)ng/ml,核小体为1.70±0.97。回收自体血中NETs成分较术前水平明显升高(P<0.0001),经过洗涤后,洗涤自体血中上述成分明显降低(P<0.0001),但仍高于术前水平(P<0.0001)。结论OPCABG术中NETs(包括细胞外DNA、核小体和MPO)的产生增加,应用IBS可降低NETs水平,但仍高于术前水平。Objective To evaluate the washing effect of intraoperative blood salvage(IBS)on neutrophil extracellular traps(NETs)in off-pump coronary artery bypass graft(OPCABG)surgery.Methods This was a retrospective study.From June to December 2017,twenty patients undergoing OPCABG surgery in Beijing Friendship Hospital were enrolled and IBS was used on every patient.The serum levels of DNA,nucleosome and myeloperoxidase(MPO)were measured on the following occasions:before anesthesia(T 0),before washing(T 1)and after filtering autologous blood(T 2).Results On the occasion of T 0,the level of DNA was 25.09(7.26,88.35)ng/ml,the level of MPO was 4.64(1.30,7.90)ng/ml and the level of nucleosome was 0.06±0.04.On the occasion of T 1,the level of DNA was 4985.59(2949.07,14171.43)ng/ml,the level of MPO was 392.33(199.12,755.11)ng/ml and the level of nucleosome was 3.11±0.24.On the occasion of T 2,the level of DNA was 330.32(197.79,1258.53)ng/ml,the level of MPO was 36.79(26.14,65.60)ng/ml,the level of nucleosome was 1.70±0.97.Compared with T 0,NETs components increased significantly in T 1(P<0.0001).Compared with T 1,NETs components decreased significantly in T 2(P<0.0001).However,compared with T 0,NETs components was still higher in T 2(P<0.0001).Conclusion Levels of NETs components can be reduced significantly by the application of IBS in OPCABG surgery,but they are still higher than preoperative levels.

关 键 词：非体外循环冠状动脉搭桥术 术中血液回收 中性粒细胞胞 外诱捕网 洗涤效果 

分 类 号：R654.2[医药卫生—外科学]