自体血回输可改善骨科手术患者血液氧合功能和降低炎性反应
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摘要
为了探讨术中自体血回输对骨科手术患者围手术期血液氧合及炎性反应的影响,本研究选择骨科手术患者52例,按随机数字表法分为自体血回输组(A组, 26例)和输异体血组(B组, 26例)。A组患者在术中给予自体血液回输,B组患者术中输注同种异体血。于术前、术中输血结束时、术后24 h,通过对两组患者分别进行桡动脉采血化验血气分析,检测动脉氧分压(PaO2)、动脉血液氧含量(CaO2),并抽取外周静脉血检测2, 3-二磷酸甘油酸(2,3-DPG)、白细胞(WBC)、C反应蛋白(CRP)。本研究发现,术中输血结束时A组PaO2、CaO2、2,3-DPG高于B组,差异有统计学意义(p<0.05);术后24 h,A组PaO2、CaO2、外周静脉、2,3-DPG均高于B组,但差异无统计学意义(p>0.05);术中,A组WBC、CRP均比B组低,但差异无统计学意义(p>0.05);A组术后24 h,WBC、CRP均比B组低,比较差异有统计学意义(p<0.05)。本研究表明,自体血回输能明显改善骨科手术患者血液氧合功能和降低炎性反应。本研究为自体血回输在骨科手术中的临床应用提供了一定的理论依据。
To evaluate the effects of intraoperative autologous blood transfusion on blood oxygenation and inflammatory response in patients on perioperative undergoing orthopedic surgery, 52 patients were selected in the department of orthopedics, and were divided into the autologous blood transfusion group(A group n=26) and the allogeneic blood transfusion group(B group n =26), according to random number table method. The patients in group A were given autologous blood transfusion and the patients in group B were given allogeneic blood transfusion. The blood samples were collected from radial artery before operation, immediately after blood transfusion and 24 h after operation, and were used for blood gas analysis. The postoperative arterial oxygen partial pressure(PaO2) and arterial blood oxygen content(CaO2) were detected, and the peripheral blood were drawn to detect 2,3-diphosphoglyceric acid, white blood cell(WBC) and C reactive protein(CRP). The results indicated that after intraoperative blood transfusion, the PaO2, CaO2 and 2,3-DPG in group A were higher than that in the group B, and the difference was statistically significant(p<0.05); In 24 h after operation, the PaO2, CaO2, peripheral vein and 2,3-DPG in group A were all higher than that in the group B, but the difference was not statistically different(p>0.05). During operation, the WBC and CRP of group A were both lower than group B,butthe difference was not statistically different(p>0.05); In 24 h after operation, the WBC and CRP of group A were all lower than that in the group B, and the difference was statistically significant(p<0.05). These results showed that autologous blood transfusion could significantly improve the blood oxygenation and reduce the inflammatory reaction. This research might provide certain theoretical basis for the clinical application of autologous blood transfusion in orthopedics surgery.
To evaluate the effects of intraoperative autologous blood transfusion on blood oxygenation and inflammatory response in patients on perioperative undergoing orthopedic surgery, 52 patients were selected in the department of orthopedics, and were divided into the autologous blood transfusion group(A group n=26) and the allogeneic blood transfusion group(B group n =26), according to random number table method. The patients in group A were given autologous blood transfusion and the patients in group B were given allogeneic blood transfusion. The blood samples were collected from radial artery before operation, immediately after blood transfusion and 24 h after operation, and were used for blood gas analysis. The postoperative arterial oxygen partial pressure(PaO2) and arterial blood oxygen content(CaO2) were detected, and the peripheral blood were drawn to detect 2,3-diphosphoglyceric acid, white blood cell(WBC) and C reactive protein(CRP). The results indicated that after intraoperative blood transfusion, the PaO2, CaO2 and 2,3-DPG in group A were higher than that in the group B, and the difference was statistically significant(p<0.05); In 24 h after operation, the PaO2, CaO2, peripheral vein and 2,3-DPG in group A were all higher than that in the group B, but the difference was not statistically different(p>0.05). During operation, the WBC and CRP of group A were both lower than group B,butthe difference was not statistically different(p>0.05); In 24 h after operation, the WBC and CRP of group A were all lower than that in the group B, and the difference was statistically significant(p<0.05). These results showed that autologous blood transfusion could significantly improve the blood oxygenation and reduce the inflammatory reaction. This research might provide certain theoretical basis for the clinical application of autologous blood transfusion in orthopedics surgery.
引文
Almac E.,and Ince C.,2007,The impact of storage on red cell function in blood transfusion,Best Pract.Res.C1in.Anaesthesiol.,21(2):195-208
Aning J.,Dunn J.,Daugherty M.,Mason R.,Pocock R.,Ridler B.,Thompson J.,and McGrath J.S.,2012,Towards bloodless cystectomy:a 10-year experience of intra-operative cell salvage during radical cystectomy,BJU Int.,110(11):608-613
Berezina T.L.,Zaets S.B.,Morgan C.,Spillert C.R.,Kamiyama M.,Spolarics Z.,Deitch E.A.,and Machiedo G.W.,2002,Influence of storage on red blood cell rheological properties,Journal of Surgical Research,102(1):6-12
Bigsby E.,Acharya M.R.,Ward A.J.,Ward A.J.,and Chesser T.J.,2013,The use of blood cell salvage in acetabular fracture internal fixation surgery,J.Orthop.Trauma,27(10):230-233
Brzica S.M.,Pineda A.A.,Taswell H.F.,and Kuban D.J.,1979,Autologous blood transfusion,Crit.Rev.Clin.Lab.Sci.,10(1):31-56
Butler J.S.,Burke J.P.,Dolan R.T.,Fitzpatrick P.,O'Byrne J.M.,McCormack D.,Synnott K.,and Poynton A.R.,2011,Risk analysis of blood transfusion requirements in emergency and elective spinal surgery,Eur.Spine J.,20(5):753-758
Che J.,Tian M.,Ding G.,Huai Q.,Dong P.,Li Y.,and Li S.,2013,Effects of cell salvage on erythrocyte 2,3-disphosphoglycerate and G-6-PD levels and phosphatidylserine expression,Int.J.Lab.Hematol.,35(4):385-392
Chen Z.,and Liu G.Y.,2016,The effects of autologous blood transfusion and acute normovolemic hemodilution inflammatory response in patients with spinal surgery,Guoji Jianyan Yixue Zazhi(International Journal of Laboratory Medicine),37(9):1202-1204(陈卓,刘光远,2016,自体血回输与急性等容量血液稀释对脊柱外科手术患者全身炎症反应的影响,国际检验医学杂志,37(9):1202-1204)
Cotwetl C.W.,Beufler E.,West C.,Hardwick M.E.,and Morris B.A.,2002,Erythrocyte viability in blood salvaged during total joint arthroplasty with cement,J.Bone Jiont Surg.,84(1):23-25
Eren O.,Ekinci S.,Biligic S.,Kose O.,Oguz E.,and Sehrloglu A.,2012,Posterior spinal fusion in adolescent idiopathic scoliosis with or without intraoperative cell salvage system:a retrospective comparison,Musculoskelet.Surg.,96(2):107-110
Foss N.B.,Kristensen M.T.,Jensen P.S.,Palm H.,Krasheninnikoff M.,and Kehlet H.,2009,The effects of liberal versus restrictive transfusion thresholds on ambulation after hip fracture suegery,Transfusion,49(2):227-234
Gladden L.B.,2008,A lactatic perspective on metabolism,Med.Sei.Sports Exere.,40(3):477-485
Gu Y.J.,Verneijden W.J.,de Vries A.J.,Hagenaars J.A.,Graaff R.,and van Oeveren W.,2008,Influence of mechanical cell salvage on red blood cell aggregation,deformability and 2,3-diphoglycerate in patients undergoing cardiac surgery with cardiopulmonary bypass,Ann.Thorac.Surg.,86(5):1570-1575
Kirnap M.,Tezcaner T.,Ayvazoglu Soy H.E.,Akdur A.,Yldrm S.,Torgay A.,Moray G.,and Haberal M.,2015,Efficacy of cell saver use in living-donor liver transplant,Exp.Clin.Transplant.,13(1):315-317
Liang J.,Shen J.,Chua S.,Fan Y.,Zhai J.,Feng B.,Cai S.,Li Z.,and Xue X.,2015,Does intraoperative cell salvage system sffectively decrease the need for allogeneic tarasfuions in scoliotic patients undergoing posterior spinal fusion?a prospective randomized study,Eur.Spine J.,24(31):270-275
Orr M.D.,1982,Autotransfusion:intraoperative scavenging,Int.Anesthesiol.Clin.,20(4):97-119
Raval J.S.,Nelson J.B.,Woldemichael E.,and Triulzi D.J.,2012,Intraoperative cell salvage in radical prostatectomy does not appear to increase long-term biochemical recurrence,metastases,or mortality,Transfusion,52(12):2590-2593
Reeder GD.,2004,Autotransfusion theory of operation:a review of the physics and hematology,Transfusion,44(12):35-39
Salaria O.N.,Barodka V.M.,Hogue C.W.,Berkowitz D.E.,Ness P.M.,Wasey J.O.,and Frank S.M.,2014,Impaired red blood cell deformability after transfusion of stored allogeneic blood but not autologous salvaged blood in cardiac surgery patients,Anesth.Analg.,118(6):1179-1187
Son M.,Evanko J.C.,Mongero L.B.,Lewin S.N.,Lu Y.S.,Herzog T.J.,Kim J.H.,and Wright J.D.,2014,Utility of cell salvage in women undergoing abdominal myomectomy,Am.J.Obstet.Gynecol.,211(1):28.e1-e8
Walsh T.S.,Palmer J.,Watson D.,Biggin K.,Seretny M.,Davidson H.,Harkness M.,and Hay A.,2012,Multicentre cohort study of red blood cell use for revision hip arthroplasty and factors associated with greater risk of allogeneic blood transfusion,Br.J.Anaesth.,108(1):63-71
Wang Y.,Ji Y.,Zhu Y.,Xie Z.,and Zhan X.,2012,Laparoscopic splenectomy and azygoportal disconnection with intraoperative splenic blood salvage,Surg.Endosc.,26(8):2195-2201
Waters J.H.,and Yazer M.H.,2015,Patient blood management:where's the bottom?Transfusion,55(4):700-702
Wu Y.,and Zhu L.K.,2016,Influence of autologous transfusion on inflammatory cytokines in patients with total hip replacement,Zhongguo Shuxue Zazhi(Chinese Journal of Blood Transfusion),29(2):165-167(吴亚,朱丽坤,2016,全髋关节置换术中自体血回输对患者炎性细胞因子的影响,中国输血杂志,29(2):165-167)
Zhao S.,Wang X.L.,Liu F.F.,Duan W.D.,Wu C.,and Tong Y.F.,2016,Effects of autologous blood transfusion on blood oxygenation at peroperative period in elderly patients receiving orthopedics surgery,Hebei Yixue(Hebei Medical Journal),38(18):2729-2732(赵爽,王秀丽,刘飞飞,段卫东,吴川,仝烨峰,2016,自体血回输对高龄骨科患者围术期血液氧合的影响,河北医药,38(18):2729-2732)
Aning J.,Dunn J.,Daugherty M.,Mason R.,Pocock R.,Ridler B.,Thompson J.,and McGrath J.S.,2012,Towards bloodless cystectomy:a 10-year experience of intra-operative cell salvage during radical cystectomy,BJU Int.,110(11):608-613
Berezina T.L.,Zaets S.B.,Morgan C.,Spillert C.R.,Kamiyama M.,Spolarics Z.,Deitch E.A.,and Machiedo G.W.,2002,Influence of storage on red blood cell rheological properties,Journal of Surgical Research,102(1):6-12
Bigsby E.,Acharya M.R.,Ward A.J.,Ward A.J.,and Chesser T.J.,2013,The use of blood cell salvage in acetabular fracture internal fixation surgery,J.Orthop.Trauma,27(10):230-233
Brzica S.M.,Pineda A.A.,Taswell H.F.,and Kuban D.J.,1979,Autologous blood transfusion,Crit.Rev.Clin.Lab.Sci.,10(1):31-56
Butler J.S.,Burke J.P.,Dolan R.T.,Fitzpatrick P.,O'Byrne J.M.,McCormack D.,Synnott K.,and Poynton A.R.,2011,Risk analysis of blood transfusion requirements in emergency and elective spinal surgery,Eur.Spine J.,20(5):753-758
Che J.,Tian M.,Ding G.,Huai Q.,Dong P.,Li Y.,and Li S.,2013,Effects of cell salvage on erythrocyte 2,3-disphosphoglycerate and G-6-PD levels and phosphatidylserine expression,Int.J.Lab.Hematol.,35(4):385-392
Chen Z.,and Liu G.Y.,2016,The effects of autologous blood transfusion and acute normovolemic hemodilution inflammatory response in patients with spinal surgery,Guoji Jianyan Yixue Zazhi(International Journal of Laboratory Medicine),37(9):1202-1204(陈卓,刘光远,2016,自体血回输与急性等容量血液稀释对脊柱外科手术患者全身炎症反应的影响,国际检验医学杂志,37(9):1202-1204)
Cotwetl C.W.,Beufler E.,West C.,Hardwick M.E.,and Morris B.A.,2002,Erythrocyte viability in blood salvaged during total joint arthroplasty with cement,J.Bone Jiont Surg.,84(1):23-25
Eren O.,Ekinci S.,Biligic S.,Kose O.,Oguz E.,and Sehrloglu A.,2012,Posterior spinal fusion in adolescent idiopathic scoliosis with or without intraoperative cell salvage system:a retrospective comparison,Musculoskelet.Surg.,96(2):107-110
Foss N.B.,Kristensen M.T.,Jensen P.S.,Palm H.,Krasheninnikoff M.,and Kehlet H.,2009,The effects of liberal versus restrictive transfusion thresholds on ambulation after hip fracture suegery,Transfusion,49(2):227-234
Gladden L.B.,2008,A lactatic perspective on metabolism,Med.Sei.Sports Exere.,40(3):477-485
Gu Y.J.,Verneijden W.J.,de Vries A.J.,Hagenaars J.A.,Graaff R.,and van Oeveren W.,2008,Influence of mechanical cell salvage on red blood cell aggregation,deformability and 2,3-diphoglycerate in patients undergoing cardiac surgery with cardiopulmonary bypass,Ann.Thorac.Surg.,86(5):1570-1575
Kirnap M.,Tezcaner T.,Ayvazoglu Soy H.E.,Akdur A.,Yldrm S.,Torgay A.,Moray G.,and Haberal M.,2015,Efficacy of cell saver use in living-donor liver transplant,Exp.Clin.Transplant.,13(1):315-317
Liang J.,Shen J.,Chua S.,Fan Y.,Zhai J.,Feng B.,Cai S.,Li Z.,and Xue X.,2015,Does intraoperative cell salvage system sffectively decrease the need for allogeneic tarasfuions in scoliotic patients undergoing posterior spinal fusion?a prospective randomized study,Eur.Spine J.,24(31):270-275
Orr M.D.,1982,Autotransfusion:intraoperative scavenging,Int.Anesthesiol.Clin.,20(4):97-119
Raval J.S.,Nelson J.B.,Woldemichael E.,and Triulzi D.J.,2012,Intraoperative cell salvage in radical prostatectomy does not appear to increase long-term biochemical recurrence,metastases,or mortality,Transfusion,52(12):2590-2593
Reeder GD.,2004,Autotransfusion theory of operation:a review of the physics and hematology,Transfusion,44(12):35-39
Salaria O.N.,Barodka V.M.,Hogue C.W.,Berkowitz D.E.,Ness P.M.,Wasey J.O.,and Frank S.M.,2014,Impaired red blood cell deformability after transfusion of stored allogeneic blood but not autologous salvaged blood in cardiac surgery patients,Anesth.Analg.,118(6):1179-1187
Son M.,Evanko J.C.,Mongero L.B.,Lewin S.N.,Lu Y.S.,Herzog T.J.,Kim J.H.,and Wright J.D.,2014,Utility of cell salvage in women undergoing abdominal myomectomy,Am.J.Obstet.Gynecol.,211(1):28.e1-e8
Walsh T.S.,Palmer J.,Watson D.,Biggin K.,Seretny M.,Davidson H.,Harkness M.,and Hay A.,2012,Multicentre cohort study of red blood cell use for revision hip arthroplasty and factors associated with greater risk of allogeneic blood transfusion,Br.J.Anaesth.,108(1):63-71
Wang Y.,Ji Y.,Zhu Y.,Xie Z.,and Zhan X.,2012,Laparoscopic splenectomy and azygoportal disconnection with intraoperative splenic blood salvage,Surg.Endosc.,26(8):2195-2201
Waters J.H.,and Yazer M.H.,2015,Patient blood management:where's the bottom?Transfusion,55(4):700-702
Wu Y.,and Zhu L.K.,2016,Influence of autologous transfusion on inflammatory cytokines in patients with total hip replacement,Zhongguo Shuxue Zazhi(Chinese Journal of Blood Transfusion),29(2):165-167(吴亚,朱丽坤,2016,全髋关节置换术中自体血回输对患者炎性细胞因子的影响,中国输血杂志,29(2):165-167)
Zhao S.,Wang X.L.,Liu F.F.,Duan W.D.,Wu C.,and Tong Y.F.,2016,Effects of autologous blood transfusion on blood oxygenation at peroperative period in elderly patients receiving orthopedics surgery,Hebei Yixue(Hebei Medical Journal),38(18):2729-2732(赵爽,王秀丽,刘飞飞,段卫东,吴川,仝烨峰,2016,自体血回输对高龄骨科患者围术期血液氧合的影响,河北医药,38(18):2729-2732)