术前自体血存储联合白细胞过滤器血液回输在体外循环心脏手术中的应用研究  

Application study of preoperative autologous blood storage combined with leukocyte filter blood reinfusion in cardiopulmonary bypass surgery

作　　者：卓海珍 黄周亮 卢佳轩 陈林 ZHUO Hai-zhen;HUANG Zhou-liang;LU Jia-xuan(Anesthesia and Surgery Center,Affiliated Hospital of Guangdong Medical University,Zhanjiang 524001,China)

机构地区：[1]广东医科大学附属医院麻醉手术中心,广东湛江524001

出　　处：《医师在线》2023年第7期3-7,共5页Journal of Doctors Online

基　　金：湛江市科技计划项目(2021B01006)。

摘　　要：目的研究术前自体血存储联合白细胞过滤器血液回输在体外循环心脏手术中的应用效果。方法将2021年5月~2022年9月于我院拟行全身麻醉体外循环下心脏直视手术的80例患者纳入研究,以计算机随机数字表将其随机分成实验组和对照组,每组40例。实验组采用术前自体血存储联合白细胞过滤器血液回输,对照组则开展术前自体血存储联合自体血直接回输。对比两组各项炎症指标、心肌标志物以及心脏彩超指标在自体血回输前后的变化情况,以及住院时间、异体用血量。结果实验组回输后体内C反应蛋白(CRP)、肿瘤坏死因子-α(TNF-α)以及白细胞介素-6(IL-6)水平分别为(13.39±0.56)mg/L、(29.21±9.20)pg/ml、(35.95±3.22)pg/ml,均低于对照组的(17.45±0.84)mg/L、(33.57±8.50)pg/ml、(40.09±4.20)pg/ml;而白细胞介素IL-10(IL-10)水平为(40.38±4.21)pg/ml,高于对照组的(30.51±6.21)pg/ml(P<0.05)。实验组术后1 d、术后5 d的血清肌酸激酶同工酶(CK-MB)、肌钙蛋白T(cTnT)、N-末端脑利钠肽前体(NT-proBNP)水平均低于对照组(P<0.05)。实验组术后左室射血分数(LVEF)、左室短轴缩短率(FS)均高于对照组(P<0.05)。实验组住院时间为(13.59±2.30)d,短于对照组的(15.77±4.10)d;而异体用血量为(241.28±24.34)ml,少于对照组的(632.89±69.29)ml(P<0.05)。结论术前自体血存储联合白细胞过滤器血液回输对体外循环心脏手术的作用效果显著,可减轻患者全身炎症反应,提高心脏保护作用,促进患者早日康复。Objective To study the function effect of preoperative autologous blood storage combined with leukocyte filter blood reinfusion in cardiopulmonary bypass surgery.Methods A total of 80 patients scheduled for cardiac direct visualization surgery under general anesthesia with cardiopulmonary bypass in our hospital from May 2021 to September 2022 were included in the study.They were randomly divided into experimental group and control group by computer-generated random number table,with 40 cases in each group.The experimental group underwent preoperative autologous blood storage combined with leukocyte filter blood reinfusion,while the control group underwent preoperative autologous blood storage combined with direct autologous blood transfusion.The changes in various inflammatory markers,myocardial markers and cardiac ultrasound parameters before and after autologous blood reinfusion were compared between the two groups,as well as hospital stay and allogeneic blood consumption.Results In the experimental group,the levels of C-reactive protein(CRP),tumor necrosis factor-α(TNF-α)and interleukin-6(IL-6)after reinfusion were(13.39±0.56)mg/L,(29.21±9.20)pg/ml and(35.95±3.22)pg/ml,respectively,which were lower than those in the control group(17.45±0.84)mg/L,(33.57±8.50)pg/ml,and(40.09±4.20)pg/ml.However,the level of interleukin-10(IL-10)was(40.38±4.21)pg/ml in the experimental group,higher than that in the control group(30.51±6.21)pg/ml(P<0.05).At postoperative day 1 and day 5,the serum levels of creatine kinase-MB(CK-MB),cardiactroponin T(cTnT)and N-terminal prohormone brain natriuretic peptide(NT-proBNP)in the experimental group were lower than those in the control group(P<0.05).The left ventricular ejection fraction(LVEF)and left ventricular short-axis shortening rate(FS)were higher in the experimental group compared to the control group(P<0.05).The hospital stay in the experimental group was(13.59±2.30)days,shorter than that in the control group(15.77±4.10)days,and the allogeneic blood consumption was(241.

关 键 词：体外循环心脏手术 术前自体血存储 白细胞过滤器 血液回输 

分 类 号：R54[医药卫生—心血管疾病]