洗涤红细胞在围手术期肝癌患者中的临床应用研究  

Clinical application of washed red blood cells in perioperative patients with liver cancer

作　　者：王雪梅[1] 王华 梁冠中 李新丽[1] 廖继成[1] 尹卫东 杨舒雅 Hua;LIANG Guanzhong;LI Xinli;LIAO Jicheng;YIN Weidong;YANG Shuya(The Sixth People′s Hospital Of Chengdu,Chengdu 610051,China;The First Affiliated Hospital of Southwest Medical University;Cancer Hospital of Chongqing)

机构地区：[1]成都市第六人民医院,四川成都610051 [2]西南医科大学附属第一医院 [3]重庆市肿瘤医院

出　　处：《中国输血杂志》2021年第8期858-860,共3页Chinese Journal of Blood Transfusion

摘　　要：目的评估洗涤红细胞在围手术期肝癌患者中的应用价值。方法将符合纳入、排除标准的86名围手术期肝癌患者分为观察组42名和对照组44名。观察组患者为输注普通红细胞组22例和输注洗涤红细胞组20例,对照组为未输注红细胞的围手术期肝癌患者。记录患者疾病名称,肿瘤分期,肿瘤大小,输血前后血红蛋白(HB),输血量和输血种类,输血不良记录,手术时间和手术出血量、全身感染情况,肿瘤转移和复发情况,生存期。比较3组患者疗效、生存期、不良反应和肿瘤复发、转移的差异。结果未输血组、洗涤红细胞组和普通红细胞组在输血前的Hb分别为(93.9±16.5)g/L、(80.4±24.5)g/L、(74.7±26.1)g/L(P<0.05),手术时间分别为(2.8±0.7)h,(4.3±1.6)h、(3.9±2.0)h(P<0.05),手术出血量分别为(291.0±0.3)mL、(388.0±165.8)mL、(466.3±198.4)mL(P<0.05)。3组输血疗效、患者生存期无差异(P>0.05)。输血组与非输血组肿瘤转移(50%vs 43%)和复发(50%vs 43.1%)有差异(P<0.05);输注普通红细胞组和输注洗涤红细胞组肿瘤转移(50%vs 48%)和复发(50%vs 49%)无差异(P>0.05);院内感染率比较中,输注洗涤红细胞组(36%)较普通红细胞输注组(88.6%)和未输血组(50%)均有差异(P<0.05)。结论低氧状态导致的输血可能引起围手术期肝癌患者的肿瘤转移和复发增加,而选用洗涤红细胞在达到输血疗效的同时可降低患者输血不良反应,对患者生存期无明显影响,具有一定推广价值。Objective To estimate the application value of washed red blood cells(RBC)in perioperative patients with liver cancer.Methods 86 perioperative patients with liver cancer who met the inclusion/exclusion criteria were divided into observation group(n=42)and control group(n=44).In the observation group,22 patients were transfused with RBC and 20 with washed RBC.Patients without RBC transfusion worked as the controls.The name of disease,tumor stage,tumor size,Hb before and after blood transfusion,transfusion volume and blood components,adverse reaction to blood transfusion,operation time and blood loss during surgery,systemic infection,tumor recurrence and metastasis,and survival time were recorded.Blood transfusion efficacy,survival time,adverse reaction to blood transfusion,tumor recurrence and metastasis among these groups were compared.Results Among the non-transfusion group,washed RBC group and RBC group,the Hb(g/L)were 93.9±16.5 vs 80.4±24.5 vs 74.7±26.1,operative time(h)2.8±0.7 vs 4.3±1.6 vs 3.9±2.0,operative blood loss(mL)291.0±0.3 vs 388.0±165.8 vs 466.3±198.4 respectively before blood transfusion(all P<0.05).There were no significant differences in the efficacy of blood transfusion and survival time among the three groups(P>0.05).There were significant differences in tumor metastasis(50%vs 43%)and recurrence(50%vs 43.1%)between blood transfusion group and non-blood transfusion group(P<0.05).There was no difference in tumor metastasis(50%vs 48%)and recurrence(50%vs 49%)between the washed RBC group and RBC group(P>0.05).The nosocomial infection rate in washed RBC group(36%)was significantly lower that that in RBC group(88.6%)and non-transfusion group(50%)(P<0.05).Conclusion Blood transfusion caused by hypoxia may increase tumor metastasis and recurrence in perioperative patients with liver cancer.Transfusion of washed RBC can achieve the curative effect and reduce adverse reactions to blood transfusion,but has no significant impact on the survival time.

关 键 词：肝癌 输血 转移 复发 不良反应 

分 类 号：R457.1[医药卫生—治疗学]