加温加压对输血效果及血液质量的影响  

Study on the Effect of Rewarmed and Pressurized Blood Transfusion and Blood Quality

作　　者：马印图 陈莉[2] 陈晓飞 刘宏 王哲 谷建芳 李莉华[2] MA Yintu(980 Hospital of PLA Joint Logistics Support Forces, Hebei Shijiazhuang 050082, China)

机构地区：[1]中国人民解放军联勤保障部队第九八〇医院输血医学科,河北石家庄050082 [2]河北省血液中心,河北石家庄050071

出　　处：《河北医学》2021年第5期859-863,共5页Hebei Medicine

基　　金：军队十三五后勤科研项目,(编号:CLB18J018)。

摘　　要：目的:研究在不同温度和压力下的输血效果以及对红细胞形态、溶血率以及血钾等指标的影响,筛选快速输血的适宜加温温度和施压强度,为研制战时加温加压输血装置提供理论依据。方法:取4℃保存10d的去白全血400mL,将加压、加温装置自上而下依次安装在输液架上,开启电源,设定加压参数分别为0kPa、5kPa、10kPa、15kPa和20kPa,将输血器管路嵌入加温仪的加温管内,通过调节温控器设置输血管路加温温度,进行模拟加温加压输注试验,检测不同施压情况下血液经过40℃、45℃、50℃、55℃加温后的升温效果和流速的变化,同时与未加温加压状态下红细胞形态、游离血红蛋白浓度和血钾指标的改变,评价加温加压后的输注效果和对血液质量的影响。结果:在低于50℃加温加压输血,红细胞溶血率波动在0.035~0.093%之间,血浆游离血红蛋白测定值在0.075~0.184g/L之间变化,血钾浓度测定值在7.44mmoL/L~9.75mmoL/L之间,三者的检测结果与加温加压输注前比较差异无统计学意义(P>0.05)。随着外界温度和压力的增加,当温度>55℃时,在高倍镜下可见少量变型红细胞和细胞碎片。血液流速与温度和施压强度呈正相关。结论:在温度<55℃、压力<20kPa的情况下加温加压输血,短时间内不会引起有意义的红细胞溶血,血液游离血红蛋白及红细胞溶血率无明显变化,血液质量不受影响,而更高的温度和压力可出现红细胞轻度溶血和形态异常的改变。血液质量完全符合《医疗机构临床用血管理办法》2012版的标准要求。Objective:To study the effect of rapid infusion and observe the change of RBC morphologic,hemolysis rate and blood potassium during the different temperature and compression in order to provide a theoretical basis for the development of wartime rewarmed and pressurized transfusion devices.Methods:The 400ml whole blood stored at 4℃for 10 days were slected.The pressurizing and rewarming devices were installed on the infusion stand before turning on the power and setting the repressurized parameters to 0Kpa,5Kpa,10Kpa,15Kpa and 20Kpa.The blood transfusion line was inserted into the rewarming tube of the heating instrument,and the thermostat was set up by adjusting the thermostat to set the heating temperature.A simulated rewarmed and pressurized infusion test was performed to detect the red blood cell morphology,the shape of the red blood cells and the blood transfusion effect after the blood flowed through the 40℃、45℃、50℃、55℃heating tube under different pressure conditions.The variety in free hemoglobin concentration,serum potassium and blood flow rate were compared to evaluate the effect of infusion on blood quality and flow rate under different temperature and pressure conditions compared with untreated.Results:In a certain range for rewarming and pressurizing blood transfusion,the red blood cell hemolysis rate fluctuates at 0.035-0.093%,the measured value of plasma free hemoglobin varied between 0.075-0.184 g/L,and the blood potassium concentration fluctuates between 7.44mmol/L-9.75mmol/L.The test results showed no significant difference before and after infusion(P>0.05).With the increase of external temperature and pressure,a small amount of deformed red blood cells and cell debris could be seen under the high magnification when the temperature is higher than 55℃.The blood flow rate was positively correlated with the temperature and pressure intensity.Conclusion:The rewarmed and pressurized blood would not cause significant erythrocyte hemolysis in a short time under the temperature below 55�

关 键 词：加温加压输血 红细胞形态 游离血红蛋白 溶血率 血液质量 

分 类 号：R457.1[医药卫生—治疗学]