自体输血与同种输血对骨科患者术后恢复的影响
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摘要
为研究自体输血与同种输血对骨科患者免疫功能、血液氧合代谢水平变化影响,本研究选取骨科手术需要输血的患者98例,根据随机数字法分为对照组和观察组。对照组患者采用单纯输注异体血,观察组患者采用自体血液回输,通过检测患者免疫功能、血液氧合代谢、丙二醛(MDA)、细胞间粘连分子-1 (ICAM-1)及基质金属蛋白酶-9 (MMP-9)水平的变化,评估两组患者的治疗疗效。研究发现,术前两组患者混合静脉血氧饱和度、氧摄取率及动、静脉乳酸量、MDA、ICAM-1及MMP-9水平比较无统计学差异(p>0.05)。术后24 h,观察组患者氧摄取率和动、静脉乳酸量、MDA、ICAM-1及MMP-9水平均低于对照组,两组患者混合静脉血氧饱和度比较无统计学差异(p>0.05)。术前,两组患者CD3~+、CD4~+、CD4~+/CD8~+、NK水平比较无统计学差异(p>0.05)。术后7 d,观察组患者免疫功能水平均优于对照组(p<0.05)。两组患者术前、术后7 d红细胞计数、血细胞比容、血红蛋白水平比较无统计学差异(p>0.05)。本研究的结果说明,自体输血对骨科术中出血量较大的患者,可以维持机体有效循环,避免机体免疫功能受损,减轻机体炎症反应,具有较好的临床应用价值。
To analyze the effect of autologous blood transfusion and allogeneic blood transfusion on immune function and blood oxygenation metabolism of orthopedic patients, 98 patients who needed blood transfusion in orthopedic surgery were divided into the control group and the observation group according to the random number method. The patients in the control group were treated by simple allogeneic blood transfusion, while the patients in the observation group were treated by autologous blood transfusion. The treatment efficacy of the two groups was analyzed as well as the effect on the immune function, blood oxygenation metabolism, malondialdehyde(MDA),intercellular adhesion molecule-1(ICAM-1) and matrix metalloproteinase-9(MMP-9) of patients. The results showed that before operation, there were no statistical difference between the two groups in the level of mixed venous oxygen saturation, oxygen uptake rate, the amount of lactic acid in vein, MDA, ICAM-1 and MMP-9(p>0.05).24 h after operation, the level of oxygen uptake rate, the amount of lactic acid in vein, MDA, ICAM-1 and MMP-9 in the observation group were lower than those in the control group. While, there was no statistical difference in mixed venous oxygen saturation between the two groups(p>0.05). Before surgery, the two groups had no significant difference on the level of CD3~+, CD4~+, CD4~+/CD8~+, and NK(p>0.05). 7 d after surgery, the immune function ofpatients in the observation group were better than that in the control group(p<0.05). Before operation and 7 d after operation, there was no significant difference on erythrocyte count, hematocrit and hemoglobin level between the two groups(p >0.05). The results indicated that autologous blood transfusion could help to maintain the effective circulation of the body, avoid the damage of immune function and reduce the inflammatory response of orthopedic patients with large amount of blood loss, which might have a good clinical application value.
To analyze the effect of autologous blood transfusion and allogeneic blood transfusion on immune function and blood oxygenation metabolism of orthopedic patients, 98 patients who needed blood transfusion in orthopedic surgery were divided into the control group and the observation group according to the random number method. The patients in the control group were treated by simple allogeneic blood transfusion, while the patients in the observation group were treated by autologous blood transfusion. The treatment efficacy of the two groups was analyzed as well as the effect on the immune function, blood oxygenation metabolism, malondialdehyde(MDA),intercellular adhesion molecule-1(ICAM-1) and matrix metalloproteinase-9(MMP-9) of patients. The results showed that before operation, there were no statistical difference between the two groups in the level of mixed venous oxygen saturation, oxygen uptake rate, the amount of lactic acid in vein, MDA, ICAM-1 and MMP-9(p>0.05).24 h after operation, the level of oxygen uptake rate, the amount of lactic acid in vein, MDA, ICAM-1 and MMP-9 in the observation group were lower than those in the control group. While, there was no statistical difference in mixed venous oxygen saturation between the two groups(p>0.05). Before surgery, the two groups had no significant difference on the level of CD3~+, CD4~+, CD4~+/CD8~+, and NK(p>0.05). 7 d after surgery, the immune function ofpatients in the observation group were better than that in the control group(p<0.05). Before operation and 7 d after operation, there was no significant difference on erythrocyte count, hematocrit and hemoglobin level between the two groups(p >0.05). The results indicated that autologous blood transfusion could help to maintain the effective circulation of the body, avoid the damage of immune function and reduce the inflammatory response of orthopedic patients with large amount of blood loss, which might have a good clinical application value.
引文
Cui B.,Zhao P.,and Wang C.,2015,The different influence of inflammatory response after transfusion with autologous blood and stored blood,Linchuang Mazuixue Zazhi(Journal of Clinical Anesthesiology),31(3):247-249(崔波,赵平,王超2015,输注自体血与库存血对患者术后炎症反应的影响临床麻醉学杂志,31(3):247-249)
Fang M.,Xia Z.Y.,Lei S.Q.,Zhao B.,and Liu L.,2016,Clinica analysis of the application of autologous blood transfusion in neurosurgery of primary hospital,Zhongguo Yishi Jinxiu Zazhi(Chinese Journal of Postgraduates of Medicine),39(8)738-741(方萌,夏中元,雷少青,赵博,刘恋,2016,自体输血在基层医院神经外科手术中应用的临床分析,中国医师进修杂志,39(8):738-741)
Fu G.W.,Wang Z.Q.,Sun W.,Zhao Y.C.,Huang M.J.,Li J.,and Zhao W.Z.,2016,Application of retrograde autologous priming combined with modified ultrafiltration in infant cardiac surgery,Zhonghua Shiyan Waike Zazhi(Chinese Journal of Experimental Surgery),33(5):1394-1396(付国伟,王振卿孙微,赵阳超,黄明君,李军,赵文增,2016,逆行自体血预充联合改良超滤技术在婴幼儿心脏手术中的应用,中华实验外科杂志,33(5):1394-1396)
Gu H.H.,Zheng S.J.,Mou X.Y.,Zhu Y.X.,Li J.Y.,and Qian BH.,2015,Influence of intraoperative blood salvage on erythro cyte osmotic fragility during orthopedic surgery,Zhongguo Shuxue Zazhi(Chinese Journal of Blood Transfusion),28(5)552-554(顾海慧,郑素娟,牟显尧,朱燕霞,李津婴,钱宝华,2015,骨科手术中自体血回输对红细胞渗透脆性的影响,中国输血杂志,28(5):552-554)
Hou D.L.,Zhang Y.,and Wu X.Y.,2015,Effects of autologous blood transfusion and allogenic blood transfusion on the patients undergoing selective operation of intervertebral fusion with cage,Zhongguo Yike Daxue Xuebao(Journal of China Medical University),44(7):636-643(侯大亮,张妍,吴秀英,2015,自体血回输与异体输血对择期行脊柱椎间融合器植入植骨融合术患者的影响,中国医科大学学报,44(7):636-643)
Huang X.H.,Zhang Y.Q.,Yao H.Q.,and Zhu H.L.,2016,Comparison of effects of allogeneic blood transfusion and hemodiluted autotransfusion on cellular immune function in patients undergoing cesarean section,Zhonghua Mazuixue Zazhi(Chinese Journal of Anesthesiology),36(2):199-202(黄新华,张雅琴,姚华琪,朱慧莉,2016,异体输血与稀释式自体输血对剖宫产术患者细胞免疫功能影响的比较,中华麻醉学杂志,36(2):199-202)
Li C.X.,2015,Significance of recycled autologous transfusion during perioperative period to remove leukocyte on immune function by erythrocyte and inflammatory response,Zhongguo Dangdai Yiyao(China Modern Medicine),22(33):54-56(李春香,2015,围术期回收式自体输血去除白细胞对患者红细胞免疫功能和炎性反应的意义,中国当代医药,22(33):54-56)
Li H.G.,Zhang Z.Y.,Huang Y.G.,and Yu X.R.,2015,Effectiveness of intraoperative autotransfusion in mild-bleeding surgery:a randomized controlled trial,Xiehe Yixue Zazhi(Medical Journal of Peking Union Medical College Hospital),10(1):9-13(李晗歌,张志永,黄宇光,虞雪融,2015,少量出血患者使用术中回收式自体输血有效性的随机对照研究,协和医学杂志,10(1):9-13)
Qiu Y.,Jin A.R.,and Guo X.X.,2005,Influence of perioperative autologous blood transfusion on serum inflammatory factors and immunoglobulin levels,Zhongguo Shuxue Zazhi(Chinese Journal of Blood Transfusion),18(1):39-40(邱颐,金阿荣,郭晓秀,2005,围术期自体输血对血清炎症性细胞因子及免疫球蛋白水平变化的影响,中国输血杂志,18(1):39-40)
Rang X.L.,Chen J.,Qin D.Q.,and Huang Y.J.,2015,Effect of autologous blood transfusion on visceral perfusion and oxygenation in patients with ectopic pregnancy bleeding,Zhongguo Yiyao Daobao(China Medical Herald),12(14):78-81(冉雪莲,陈峻,秦东全,黄燕娟,2015,自体血回输对异位妊娠大出血患者内脏灌注及氧合的影响,中国医药导报,12(14):78-81)
Rong X.Y.,Guo X.Y.,Zeng H.,Wang J.,and Wang Y.,2017,Application of intraoperative cell salvage in obstetric patients,Zhongguo Shuxue Zazhi(Chinese Journal of Blood Transfusion),30(1):94-98(容晓莹,郭向阳,曾鸿,王军,王阳,2017,术中回收式自体输血在产科患者中的应用,中国输血杂志,30(1):94-98)
Xu F.,Cheng J.,Li Z.J.,and Liu J.,2015,Influence of autologous blood transfusion on hematal and serological index of operation patients,Xinjiang Yiyao(Xinjiang Medical Journal),45(10):1436-1438(徐峰,程江,李振江,柳杰,2015,回收式自体输血对手术患者血液及血清学指标的影响,新疆医学,45(10):1436-1438)
Xue X.Y.,Yang G.P.,Xu M.K.,and Cao D.Q.,2013,The effect analysis of hemodilution and autotransfusion application in orthopedic operation,Zhongguo Xiandai Yisheng(China Modern Doctor),51(15):32-33(薛晓英,杨光平,徐明坤,曹殿青,2013,急性等容血液稀释自体输血用于骨科手术中效果分析,中国现代医生,51(15):32-33)
Yu S.,Huang Y.W.,Fu Z.S.,Lin M.X.,Wu Y.Q.,Feng Q.,Wei W.,and Yu Y.,2016,Preoperative blood donation in posterior lumbar surgery:a retrospective review,Zhongguo Shuxue Zazhi(Chinese Journal of Blood Transfusion),29(1):71-73(于帅,黄用文,付振书,林梦霞,吴月清,冯倩,闻巍,于洋,2016,预存式自体输血在腰椎后路手术中的应用,中国输血杂志,29(1):71-73)
Zeng Y.J.,Ye H.F.,Wu Y.J.,and Cai C.C.,2016,Influence of salvaged autotransfusion on hemorheology and blood coagulation in patients undergoing obstetrical operation,Zhongguo Shuxue Zazhi(Chinese Journal of Blood Transfusion),29(2):159-161(曾雅静,叶惠芬,吴远军,蔡川川,2016,回收式自体输血对产科手术患者血液流变学和凝血功能的影响,中国输血杂志,29(2):159-161)
Fang M.,Xia Z.Y.,Lei S.Q.,Zhao B.,and Liu L.,2016,Clinica analysis of the application of autologous blood transfusion in neurosurgery of primary hospital,Zhongguo Yishi Jinxiu Zazhi(Chinese Journal of Postgraduates of Medicine),39(8)738-741(方萌,夏中元,雷少青,赵博,刘恋,2016,自体输血在基层医院神经外科手术中应用的临床分析,中国医师进修杂志,39(8):738-741)
Fu G.W.,Wang Z.Q.,Sun W.,Zhao Y.C.,Huang M.J.,Li J.,and Zhao W.Z.,2016,Application of retrograde autologous priming combined with modified ultrafiltration in infant cardiac surgery,Zhonghua Shiyan Waike Zazhi(Chinese Journal of Experimental Surgery),33(5):1394-1396(付国伟,王振卿孙微,赵阳超,黄明君,李军,赵文增,2016,逆行自体血预充联合改良超滤技术在婴幼儿心脏手术中的应用,中华实验外科杂志,33(5):1394-1396)
Gu H.H.,Zheng S.J.,Mou X.Y.,Zhu Y.X.,Li J.Y.,and Qian BH.,2015,Influence of intraoperative blood salvage on erythro cyte osmotic fragility during orthopedic surgery,Zhongguo Shuxue Zazhi(Chinese Journal of Blood Transfusion),28(5)552-554(顾海慧,郑素娟,牟显尧,朱燕霞,李津婴,钱宝华,2015,骨科手术中自体血回输对红细胞渗透脆性的影响,中国输血杂志,28(5):552-554)
Hou D.L.,Zhang Y.,and Wu X.Y.,2015,Effects of autologous blood transfusion and allogenic blood transfusion on the patients undergoing selective operation of intervertebral fusion with cage,Zhongguo Yike Daxue Xuebao(Journal of China Medical University),44(7):636-643(侯大亮,张妍,吴秀英,2015,自体血回输与异体输血对择期行脊柱椎间融合器植入植骨融合术患者的影响,中国医科大学学报,44(7):636-643)
Huang X.H.,Zhang Y.Q.,Yao H.Q.,and Zhu H.L.,2016,Comparison of effects of allogeneic blood transfusion and hemodiluted autotransfusion on cellular immune function in patients undergoing cesarean section,Zhonghua Mazuixue Zazhi(Chinese Journal of Anesthesiology),36(2):199-202(黄新华,张雅琴,姚华琪,朱慧莉,2016,异体输血与稀释式自体输血对剖宫产术患者细胞免疫功能影响的比较,中华麻醉学杂志,36(2):199-202)
Li C.X.,2015,Significance of recycled autologous transfusion during perioperative period to remove leukocyte on immune function by erythrocyte and inflammatory response,Zhongguo Dangdai Yiyao(China Modern Medicine),22(33):54-56(李春香,2015,围术期回收式自体输血去除白细胞对患者红细胞免疫功能和炎性反应的意义,中国当代医药,22(33):54-56)
Li H.G.,Zhang Z.Y.,Huang Y.G.,and Yu X.R.,2015,Effectiveness of intraoperative autotransfusion in mild-bleeding surgery:a randomized controlled trial,Xiehe Yixue Zazhi(Medical Journal of Peking Union Medical College Hospital),10(1):9-13(李晗歌,张志永,黄宇光,虞雪融,2015,少量出血患者使用术中回收式自体输血有效性的随机对照研究,协和医学杂志,10(1):9-13)
Qiu Y.,Jin A.R.,and Guo X.X.,2005,Influence of perioperative autologous blood transfusion on serum inflammatory factors and immunoglobulin levels,Zhongguo Shuxue Zazhi(Chinese Journal of Blood Transfusion),18(1):39-40(邱颐,金阿荣,郭晓秀,2005,围术期自体输血对血清炎症性细胞因子及免疫球蛋白水平变化的影响,中国输血杂志,18(1):39-40)
Rang X.L.,Chen J.,Qin D.Q.,and Huang Y.J.,2015,Effect of autologous blood transfusion on visceral perfusion and oxygenation in patients with ectopic pregnancy bleeding,Zhongguo Yiyao Daobao(China Medical Herald),12(14):78-81(冉雪莲,陈峻,秦东全,黄燕娟,2015,自体血回输对异位妊娠大出血患者内脏灌注及氧合的影响,中国医药导报,12(14):78-81)
Rong X.Y.,Guo X.Y.,Zeng H.,Wang J.,and Wang Y.,2017,Application of intraoperative cell salvage in obstetric patients,Zhongguo Shuxue Zazhi(Chinese Journal of Blood Transfusion),30(1):94-98(容晓莹,郭向阳,曾鸿,王军,王阳,2017,术中回收式自体输血在产科患者中的应用,中国输血杂志,30(1):94-98)
Xu F.,Cheng J.,Li Z.J.,and Liu J.,2015,Influence of autologous blood transfusion on hematal and serological index of operation patients,Xinjiang Yiyao(Xinjiang Medical Journal),45(10):1436-1438(徐峰,程江,李振江,柳杰,2015,回收式自体输血对手术患者血液及血清学指标的影响,新疆医学,45(10):1436-1438)
Xue X.Y.,Yang G.P.,Xu M.K.,and Cao D.Q.,2013,The effect analysis of hemodilution and autotransfusion application in orthopedic operation,Zhongguo Xiandai Yisheng(China Modern Doctor),51(15):32-33(薛晓英,杨光平,徐明坤,曹殿青,2013,急性等容血液稀释自体输血用于骨科手术中效果分析,中国现代医生,51(15):32-33)
Yu S.,Huang Y.W.,Fu Z.S.,Lin M.X.,Wu Y.Q.,Feng Q.,Wei W.,and Yu Y.,2016,Preoperative blood donation in posterior lumbar surgery:a retrospective review,Zhongguo Shuxue Zazhi(Chinese Journal of Blood Transfusion),29(1):71-73(于帅,黄用文,付振书,林梦霞,吴月清,冯倩,闻巍,于洋,2016,预存式自体输血在腰椎后路手术中的应用,中国输血杂志,29(1):71-73)
Zeng Y.J.,Ye H.F.,Wu Y.J.,and Cai C.C.,2016,Influence of salvaged autotransfusion on hemorheology and blood coagulation in patients undergoing obstetrical operation,Zhongguo Shuxue Zazhi(Chinese Journal of Blood Transfusion),29(2):159-161(曾雅静,叶惠芬,吴远军,蔡川川,2016,回收式自体输血对产科手术患者血液流变学和凝血功能的影响,中国输血杂志,29(2):159-161)