人工膜肺用于血液回输前一氧化氮负载的研究  

Erythrocyte nitric oxide loading by using membrane oxygenator before blood transfusion

作　　者：赵静 陈涛 李三中 侯丽宏 雷翀 Zhao Jing;Chen Tao;Li Sanzhong;Hou Lihong;Lei Chong(Department of Anesthesiology and Perioperative Medicine,Xijing Hospital,Air Force Medical University,Shaanxi Xi'an,710032,China)

机构地区：[1]空军军医大学西京医院麻醉与围术期医学科,西安710032 [2]空军军医大学西京医院心脏外科,西安710032 [3]空军军医大学西京医院神经外科,西安710032

出　　处：《中国体外循环杂志》2021年第5期303-307,320,共6页Chinese Journal of Extracorporeal Circulation

基　　金：国家自然科学基金资助项目(81970448);陕西省国际科技合作计划项目(2019KW-069)。

摘　　要：目的建立含游离血红蛋白(fHb)的红细胞制品的体外一氧化氮(NO)负载模型,以减少血液回输时的不良反应,并初步探索适合的负载参数。方法使用聚丙烯(PP)材质的人工膜肺对5例主动脉夹层手术后患者的残余机血进行NO负载,通过比较20 ml/min、15 ml/min、10 ml/min及5 ml/min不同血流速度下负载后,血液消耗NO的能力、fHb、高铁血红蛋白、血K+浓度的变化,验证负载模型的有效性;通过比较四种不同血流速度在负载效率和安全性方面的优劣,确定适合临床使用的负载参数。结果PP材质人工膜肺用于体外NO负载可有效降低血中fHb消耗NO的能力;其中20 ml/min的血流速度进行负载时较其他血流速度负载更快速、高效;该模型可引起轻度的红细胞破坏,但因溶血而产生的fHb升高和血K+浓度的升高较基础值无统计学差异;使用该模型进行NO负载后,血中高铁血红蛋白比例升高,但总比例低于3%,远低于影响氧输送的临床危急值。结论PP材质的人工膜肺可有效用于含大量fHb的红细胞制品的体外NO负载模型的建立,具有安全、高效的特点,在该模型中推荐使用20 ml/min的血流速度进行NO负载。Objective To establish an in vitro nitric oxide(NO)preloading model for red blood cell products which containing excessive amount of free hemoglobin(fHb),and to explore the suitable preloading parameters in order to reduce the adverse reactions associated with blood transfusion.Methods Residual blood from the cardiopulmonary bypass(CPB)circuit of 5 patients with ascend⁃ing aortic aneurysm dissection was loaded with NO by using polypropylene(PP)membrane oxygenator.The changes of blood NO con⁃sumption capacity,fHb,methemoglobin and K+concentration were compared before and after the NO preloading process to verify the effectiveness of NO preloading under four different blood flow velocities(20 ml/min,15 ml/min,10 ml/min and 5 ml/min)through the oxygenator.In addition,the efficiency and safeness of NO preloading under the four blood flow velocities were compared so as to i⁃dentify the optimal preloading parameters for clinical use.Results PP membrane oxygenator was effective in ex vivo NO preloading as demonstrated by the reduced NO comsumption.The effectiveness of NO preloading was maximized under the blood flow velocity of 20 ml/min over other three blood flow velocities.The process of NO loading caused mild red blood cell damage,however,the increase of fHb and K+concentrations caused by hemolysis after NO preloading were not significantly different from the baseline value.The methe⁃moglobin level increased after NO preloading,which was less than 3%,far beyond the clinical critical value that affecting oxygen deliv⁃ery.Conclusion PP membrane oxygenator can be safely and effectively used for ex vivo NO preloading in red blood cell products con⁃taining a large amount of fHb.20 ml/min is the recommended velocity of blood flow through the oxygenator during NO preloading.

关 键 词：剩余机血 游离血红蛋白 一氧化氮 负载模型 膜肺 

分 类 号：R457.1[医药卫生—治疗学]