自体输血对骨科手术患者抗感染免疫功能的影响
摘要
目的探索不同自体输血方式在骨科手术输血后对机体产生的抗感染免疫效应,为骨科手术合理用血提供科学的理论依据。方法在征得患者知情同意的前提下,选取临床一般资料大致相似的择期手术患者60例,随机分为四组,每组15例,依次为异体输血组(allogeneic blood transfusion,ABT)(GroupⅠ,G1)、血液稀释组(acute nomovolamic haemodilution,ANH)(GroupⅡ,G2)、血液回收组(intraoperative autotransfusion,IAT)(GroupⅢ,G3)和血液稀释与血液回收两种方式联合应用组(ANH及IAT)(GroupⅣ,G4)。各组均于术前及术后第1、7、14天清晨抽取空腹患者外周静脉血10ml,用于检测IgG、IgM、补体C3a、IL-8及TNF-α含量;采用免疫投射比浊法测定IgG、IgM含量,采用放射免疫法测定补体C3a、炎症细胞因子IL-8及TNF-α含量。结果术前各组IgG、IgM、补体C3a、IL-8及TNF-α含量相比均无统计学差异(P>0.05)。术后G1 IgG、IgM较术前降低(P<0.05),G2.3.4IgM较G1高且与G1有统计学差异(P<0.05)。术后G2.3.4补体C3a、IL-8、TNF-α较术前均升高(均为P<0.05),与G1有统计学差异(P<0.05)。G4与G2.3相比,术后G4补体C3a、TNF-α较早升高且升高明显,术后第14天G4补体C3a较G3高且与G3有统计学差异(P<0.05)。结论⑴自体输血患者较异体输血患者输血后抗感染免疫能力增强。⑵血液稀释和血液回收两种自体输血方式单独应用对机体抗感染免疫能力的影响没有差异。⑶血液稀释和血液回收两种方式联合应用有助于提高机体的抗感染免疫能力,较单独应用抗感染免疫能力增强。
Objective To explore anti-infective immunological effects of different autologous transfusion after orthopaedic operations,and to further provide scientific theoretical proofs for reasonable using of blood during orthopaedic operations.Methods Under the prerequisite of kowning fact and consent of the patients,60 cases patients undertaken selective operation were choosed and divided into 4 groups at random with 15 for each group,all of which were in similar situation.The groups are ABT group(group1,G1),ANH group(group2,G2),IAT group(group3,G3),group of combind ANH and IAT (ANH+IAT)(group 4,G4).Taking groupⅠas the control, other three groups as experiment groups.The vein blood samples were taken before surgery and on the day 1,7 and 14 after surgery.The content of immunity globulin was measured by project immunity method,complement C3a and inflammation cytokine with radiation immunity method.Results Before induction of operation the IgG、IgM、C3a、IL-8 and TNF-αin each group were not significantly different from those in other groups(P>0.05). Comparing with those at base line,the IgG decreased significantly(p<0.05) in groupⅠafter operation.Comparing with those at base line,the IgM decreased significantly(p<0.05) in groupⅠafter operation;and were significantly different from groupⅡ、ⅢandⅣ(p<0.05). Comparing with those at base line,the C3a、IL-8、TNF-αincreased significantly(p<0.05)in groupⅡ、ⅢandⅣafter operation;and were significantly different from groupⅠ(p<0.05). Comparing with groupⅡ、Ⅲ, the C3a、TNF-αincreased earlier and higher in groupⅣ; Comparing with groupⅢ,the C3a increased significantly(p<0.05)in groupⅣ.Conclusion Comparing allogeneic transfusion with autologous transfusion,the latter enhance anti-infective immunopotency.There is not significantly different between ANH and IAT in immune function.The combined method of ANH and IAT is more useful for the promotion of anti-infective immunopotency.
Objective To explore anti-infective immunological effects of different autologous transfusion after orthopaedic operations,and to further provide scientific theoretical proofs for reasonable using of blood during orthopaedic operations.Methods Under the prerequisite of kowning fact and consent of the patients,60 cases patients undertaken selective operation were choosed and divided into 4 groups at random with 15 for each group,all of which were in similar situation.The groups are ABT group(group1,G1),ANH group(group2,G2),IAT group(group3,G3),group of combind ANH and IAT (ANH+IAT)(group 4,G4).Taking groupⅠas the control, other three groups as experiment groups.The vein blood samples were taken before surgery and on the day 1,7 and 14 after surgery.The content of immunity globulin was measured by project immunity method,complement C3a and inflammation cytokine with radiation immunity method.Results Before induction of operation the IgG、IgM、C3a、IL-8 and TNF-αin each group were not significantly different from those in other groups(P>0.05). Comparing with those at base line,the IgG decreased significantly(p<0.05) in groupⅠafter operation.Comparing with those at base line,the IgM decreased significantly(p<0.05) in groupⅠafter operation;and were significantly different from groupⅡ、ⅢandⅣ(p<0.05). Comparing with those at base line,the C3a、IL-8、TNF-αincreased significantly(p<0.05)in groupⅡ、ⅢandⅣafter operation;and were significantly different from groupⅠ(p<0.05). Comparing with groupⅡ、Ⅲ, the C3a、TNF-αincreased earlier and higher in groupⅣ; Comparing with groupⅢ,the C3a increased significantly(p<0.05)in groupⅣ.Conclusion Comparing allogeneic transfusion with autologous transfusion,the latter enhance anti-infective immunopotency.There is not significantly different between ANH and IAT in immune function.The combined method of ANH and IAT is more useful for the promotion of anti-infective immunopotency.
引文
[1] Singler RC,Furman EB.How low a minimun hematocrit?Anesthesiology,2001,23(5):72.
[2] Bailey TE Jr,Mahoney OM.The use of banked autologous blood in patients undergoing surgery for spinal deformity.J Bone Joint Surg Am,2003,69:329-332
[3] R Sousa,JC Salinas,M Navarro,et al.Autologous blood transfusion as an immunomodulator in experimenta sepsis. J Surg Investig,2000,1(5):365-371
[4] Ely L,Steinberg,Peleg Ben-Galim,et al.Comparative analysis of the benefits of autotransfusion of blood by a shed blood collector after total knee replacement.Arch Orthop Trauma Surg,2004,124:114–118
[5] A Gharehbaghian,KM Haque,C Truman,et al.Effect of autologous salvaged blood on postoperative natural killer cell precursor frequency. Lancet,2004,3:1025-1030
[6] J Hill and V James.Survey of autologous blood transfusion activity in England (2001). Transfus Med, 2003,13(1): 9-15
[7] Kendall SJ,Weir J,Aspinall R,et al.Erythrocyte transfusion cause immunosuppression after hip replacement.Clin Orthop,2000,381:145
[8] Shander A.Emerging risks and outcomes of blood transfusion in surgery. Semin Hematol, 2004,41(1 Suppl 1):117-124
[9] Murphy GJ,Rogers CS,Lansdowne WB,et al.Safety,efficacy,and cost of intraoperative cell salvage and autotransfusion after off-pump coronary artery bypass surgery:a randomized trial.J Thorac Cardiovasc Surg,2005,130(1):20-28
[10] 龚非力主编.医学免疫学(M).北京:科学出版社,2000,273-282
[11] Wong JC,Torella F,Haynes SL,et al.Autologous versus allogeneic transfusion in aortic surgery:a multicenter randomized clinical trial. Ann Surg,2002,235(1):145-151
[12] Blajchman MA,Immunomodulation and blood transfusion.Am J Ther,2002,9(5):389-395
[13] Saricaoglu F,Akinci SB,Celiker V,et al.The effect of acute normovolemic hemodilution and acute hypervolemic hemodilution on coagulation and allogeneic transfusion.Saudi Med J,2005,26(5):792-793
[14] 程桥,吕洁萍,董力武.等容量血液稀释及自身输血的临床应用初探.中国输血杂志,2001,10(3):131-132
[15] Torella F,Haynes SL,Kirwan CC,et al.Acute normovolemic hemodilution and intraoperative cell salvage in aortic surgery. J Vasc Surg,2002,36(1):31-34
[16] 刘俊杰主编.现代麻醉学(M).北京:人民卫生出版社,1997,683
[17] 张红斌,谭武菊,许永广,等.麻醉方法对上腹部手术围术期血清 IL-6,皮质醇及 T 细胞亚群的影响.中华麻醉学杂志,2000,20:220~222
[18] 魏淑明,陆萍,李继云,等.围术期采用硬膜外镇痛对安氟醚复合麻醉下癌症手术病人免疫抑制的影响.中华麻醉学杂志,1999,19:400~402
[19] Murray D.Acute normovolemic hemodilution.Eur Spine J,2004,13 Suppl 1:72-75
[20] Cross JB.Anesthesiology,l983,56:577
[21] 龚非力主编.医学免疫学(M).北京:科学出版社,2000,37-38
[22] 龚非力主编.医学免疫学(M).北京:科学出版社,2000,38-39
[23] 龚非力主编.医学免疫学(M).北京:科学出版社,2000,62-63
[24] 龚非力主编.医学免疫学(M).北京:科学出版社,2000,85
[25] 陈雪红,马冬梅.肺癌患者血清中肿瘤坏死因子与白细胞介素 2 测定及临床意义[J].临床内科杂志,2001,17(1):557.
[26] 杨伟,戴建伟.围术期自体/异体输血对食管癌病人免疫功能的影.国际医药卫生导报,2005,11(20):11-12
[27] Tietze M,Kluter H,Torch M,et al.Immune responsiveness in orthopedic surgery patients after transfusion of autologous or allogeneic blood.Transfusion,1998,35(5):378-383
[28] J.O.Bordin,A.K.chiba,K.I.L.Carvalho,et al.The effect of unmodified or prestorage white cell-reduced allogeneic red cell transfusions on the immune responsiveness in orthoedic surgery patients. Transfusion,1999,39(7):718
[29] Petra Innerhofer1,Anton Klingler1,Christian Klimmer1.Risk for postoperative infection after transfusion of white blood cell filtered allogeneic or autologous blood components in orthopedic patients undergoing primary arthroplasty. Transfusion,2005,45(1):103
[30] Jacobi KE,Wanke C,Jacobi A,et al.Determination of eicosanoid and cytokine production in salvaged blood:stored red blood cell concentrates,and whole blood.J Clin Anesth,2000,12(2):94-99
[31] Avall A,Peterman TA.Transfusion associated aquired immunodeficiency syndrorm. Surgery[J], 1999,39(3):271
[32] Perttila JT,Salo MS,Talonen JR,et al.Blood transfusion with autologous and leukocyte depleted or standard allogeneic red blood cell and the immune responses to open heart surgery.Anesth Analg,2000,79:654
[1] Popovsky MA.Atuologous blood transfusion in the 1990s.Where is it heading?Am J Clin Pathol,1992,97(3):297-300
[2] Rutherford RB.Vascular Surgery 3rd Edition Pennsylvania[M].W B Saunders Company,1989,375-382
[3] 谭复明,骆抗先,王专明,等.输血后乙型及丙型肝炎病毒感染的前瞻性调查.中华肝脏病杂志,1997,5:42-43
[4] Fernandez LA,Macsween JM,You CK,et al.Immunologic changes after blood transfusion in patients undergoing vascular surgery[J].AM J Surg,1992,163(2):263
[5] Salinas JC,Cabezali R,Torcal J,et al.Immune response and eytokines in septic rats undergoing blood transfusion[J].J Surg Res,1998,80(2):295
[6] 李艳萍,王旭东,李珏,钟亮.异体或自体输血对髋关节置换术病人免疫功能的影响.中华麻醉学杂志,2001,21(11):698-699
[7] Blumbery N ,Heal JM.Arch pathol lab Med[J]. Am J Med,1997,34(3 suppl 2):23
[8] Nielsen H J.Detrimental effects of perioperative blood transfusion[J]. Br J Surg,1995,82(5):582-587
[9] Way mack JP,Robb E,Alexander JW,et al.Effect of transfusion on immune function in a traumatized animal model[J].Arch Surg,1987,122(8):935-939
[10] Pinto V,Baldonedo R,Nicolas A,et al.Relationship of transfusion and infectious complications after gastric carcinoma operations.Transfusion [J] ,1991,31(2):114-118
[11] Ford CD ,Vanmoorleghem G,Menlove RL.Blood transfusion and postoperative wound infection.Surgery[J] ,1993,113(6):603-607
[12] 符晓阳,袁记,杨金华.胃肠道肿瘤患者围手术期输血与术后感染的关系.河南外科学杂志,2005,11(1):45
[13] Jacobi KE,Wanke C ,Jacobi A,et al.Determination of eicosanoid and cytokine production in salvaged blood;stored red blood cell concentrates and whole blood.J Clin Anesth,2000,12(2):94-99
[14] 孙艳红,王俊科,刘海梅.自体血回输及异体输血前后患者血浆 IL-2 及 IL-6 的变化.临床麻醉学杂志,2002,18(4):195-197
[15] Anmed ST,Jvashkw LB,Ihibition of IL-6 and IL-10 signaling and statactivation by inflammatory and stress pathways.J Immunal,2000,165(9):5227-5237
[16] Heiss MM,Mempel W,Jauch KW,et al.Beneficial effect of autologous blood transfusion on infectious complications after colorectal cancer.Surgery[J],1997,73:237
[17] Avall E,Peterman TA.Transfusion associated aquired immunodeficiency syndrorm.Surgery[J],1997,17:2657
[18] Perttila JT,Salo MS,Talonen JR,et al.Blood transfusion with autologous and leukocyte depleted or standard allogeneic red blood cell and the immune responses to open heart surgery.Anesth Analg,2000,79:654
[19] Hanse E ,Wolff N,Knue chel R,et al.Tumor cell in blood shed from the surgical field.Arch Surg,1995,130(4):387-393
[20] 李大鹏,徐学芳,任红,等.自体输血在骨科手术中的应用.中国矫形外科杂志,2001,8(12):1240-1241
[21] 邱颐,金阿荣,高桂英,等.自体输血在骨科手术中的应用.内蒙古医学杂志,2001,33(2):143-145
[22] 周柏发,肖玉,刘风英.输血对脑膜瘤患者术后感染的影响观察.中国输血杂志,2001,14(3):141-142
[2] Bailey TE Jr,Mahoney OM.The use of banked autologous blood in patients undergoing surgery for spinal deformity.J Bone Joint Surg Am,2003,69:329-332
[3] R Sousa,JC Salinas,M Navarro,et al.Autologous blood transfusion as an immunomodulator in experimenta sepsis. J Surg Investig,2000,1(5):365-371
[4] Ely L,Steinberg,Peleg Ben-Galim,et al.Comparative analysis of the benefits of autotransfusion of blood by a shed blood collector after total knee replacement.Arch Orthop Trauma Surg,2004,124:114–118
[5] A Gharehbaghian,KM Haque,C Truman,et al.Effect of autologous salvaged blood on postoperative natural killer cell precursor frequency. Lancet,2004,3:1025-1030
[6] J Hill and V James.Survey of autologous blood transfusion activity in England (2001). Transfus Med, 2003,13(1): 9-15
[7] Kendall SJ,Weir J,Aspinall R,et al.Erythrocyte transfusion cause immunosuppression after hip replacement.Clin Orthop,2000,381:145
[8] Shander A.Emerging risks and outcomes of blood transfusion in surgery. Semin Hematol, 2004,41(1 Suppl 1):117-124
[9] Murphy GJ,Rogers CS,Lansdowne WB,et al.Safety,efficacy,and cost of intraoperative cell salvage and autotransfusion after off-pump coronary artery bypass surgery:a randomized trial.J Thorac Cardiovasc Surg,2005,130(1):20-28
[10] 龚非力主编.医学免疫学(M).北京:科学出版社,2000,273-282
[11] Wong JC,Torella F,Haynes SL,et al.Autologous versus allogeneic transfusion in aortic surgery:a multicenter randomized clinical trial. Ann Surg,2002,235(1):145-151
[12] Blajchman MA,Immunomodulation and blood transfusion.Am J Ther,2002,9(5):389-395
[13] Saricaoglu F,Akinci SB,Celiker V,et al.The effect of acute normovolemic hemodilution and acute hypervolemic hemodilution on coagulation and allogeneic transfusion.Saudi Med J,2005,26(5):792-793
[14] 程桥,吕洁萍,董力武.等容量血液稀释及自身输血的临床应用初探.中国输血杂志,2001,10(3):131-132
[15] Torella F,Haynes SL,Kirwan CC,et al.Acute normovolemic hemodilution and intraoperative cell salvage in aortic surgery. J Vasc Surg,2002,36(1):31-34
[16] 刘俊杰主编.现代麻醉学(M).北京:人民卫生出版社,1997,683
[17] 张红斌,谭武菊,许永广,等.麻醉方法对上腹部手术围术期血清 IL-6,皮质醇及 T 细胞亚群的影响.中华麻醉学杂志,2000,20:220~222
[18] 魏淑明,陆萍,李继云,等.围术期采用硬膜外镇痛对安氟醚复合麻醉下癌症手术病人免疫抑制的影响.中华麻醉学杂志,1999,19:400~402
[19] Murray D.Acute normovolemic hemodilution.Eur Spine J,2004,13 Suppl 1:72-75
[20] Cross JB.Anesthesiology,l983,56:577
[21] 龚非力主编.医学免疫学(M).北京:科学出版社,2000,37-38
[22] 龚非力主编.医学免疫学(M).北京:科学出版社,2000,38-39
[23] 龚非力主编.医学免疫学(M).北京:科学出版社,2000,62-63
[24] 龚非力主编.医学免疫学(M).北京:科学出版社,2000,85
[25] 陈雪红,马冬梅.肺癌患者血清中肿瘤坏死因子与白细胞介素 2 测定及临床意义[J].临床内科杂志,2001,17(1):557.
[26] 杨伟,戴建伟.围术期自体/异体输血对食管癌病人免疫功能的影.国际医药卫生导报,2005,11(20):11-12
[27] Tietze M,Kluter H,Torch M,et al.Immune responsiveness in orthopedic surgery patients after transfusion of autologous or allogeneic blood.Transfusion,1998,35(5):378-383
[28] J.O.Bordin,A.K.chiba,K.I.L.Carvalho,et al.The effect of unmodified or prestorage white cell-reduced allogeneic red cell transfusions on the immune responsiveness in orthoedic surgery patients. Transfusion,1999,39(7):718
[29] Petra Innerhofer1,Anton Klingler1,Christian Klimmer1.Risk for postoperative infection after transfusion of white blood cell filtered allogeneic or autologous blood components in orthopedic patients undergoing primary arthroplasty. Transfusion,2005,45(1):103
[30] Jacobi KE,Wanke C,Jacobi A,et al.Determination of eicosanoid and cytokine production in salvaged blood:stored red blood cell concentrates,and whole blood.J Clin Anesth,2000,12(2):94-99
[31] Avall A,Peterman TA.Transfusion associated aquired immunodeficiency syndrorm. Surgery[J], 1999,39(3):271
[32] Perttila JT,Salo MS,Talonen JR,et al.Blood transfusion with autologous and leukocyte depleted or standard allogeneic red blood cell and the immune responses to open heart surgery.Anesth Analg,2000,79:654
[1] Popovsky MA.Atuologous blood transfusion in the 1990s.Where is it heading?Am J Clin Pathol,1992,97(3):297-300
[2] Rutherford RB.Vascular Surgery 3rd Edition Pennsylvania[M].W B Saunders Company,1989,375-382
[3] 谭复明,骆抗先,王专明,等.输血后乙型及丙型肝炎病毒感染的前瞻性调查.中华肝脏病杂志,1997,5:42-43
[4] Fernandez LA,Macsween JM,You CK,et al.Immunologic changes after blood transfusion in patients undergoing vascular surgery[J].AM J Surg,1992,163(2):263
[5] Salinas JC,Cabezali R,Torcal J,et al.Immune response and eytokines in septic rats undergoing blood transfusion[J].J Surg Res,1998,80(2):295
[6] 李艳萍,王旭东,李珏,钟亮.异体或自体输血对髋关节置换术病人免疫功能的影响.中华麻醉学杂志,2001,21(11):698-699
[7] Blumbery N ,Heal JM.Arch pathol lab Med[J]. Am J Med,1997,34(3 suppl 2):23
[8] Nielsen H J.Detrimental effects of perioperative blood transfusion[J]. Br J Surg,1995,82(5):582-587
[9] Way mack JP,Robb E,Alexander JW,et al.Effect of transfusion on immune function in a traumatized animal model[J].Arch Surg,1987,122(8):935-939
[10] Pinto V,Baldonedo R,Nicolas A,et al.Relationship of transfusion and infectious complications after gastric carcinoma operations.Transfusion [J] ,1991,31(2):114-118
[11] Ford CD ,Vanmoorleghem G,Menlove RL.Blood transfusion and postoperative wound infection.Surgery[J] ,1993,113(6):603-607
[12] 符晓阳,袁记,杨金华.胃肠道肿瘤患者围手术期输血与术后感染的关系.河南外科学杂志,2005,11(1):45
[13] Jacobi KE,Wanke C ,Jacobi A,et al.Determination of eicosanoid and cytokine production in salvaged blood;stored red blood cell concentrates and whole blood.J Clin Anesth,2000,12(2):94-99
[14] 孙艳红,王俊科,刘海梅.自体血回输及异体输血前后患者血浆 IL-2 及 IL-6 的变化.临床麻醉学杂志,2002,18(4):195-197
[15] Anmed ST,Jvashkw LB,Ihibition of IL-6 and IL-10 signaling and statactivation by inflammatory and stress pathways.J Immunal,2000,165(9):5227-5237
[16] Heiss MM,Mempel W,Jauch KW,et al.Beneficial effect of autologous blood transfusion on infectious complications after colorectal cancer.Surgery[J],1997,73:237
[17] Avall E,Peterman TA.Transfusion associated aquired immunodeficiency syndrorm.Surgery[J],1997,17:2657
[18] Perttila JT,Salo MS,Talonen JR,et al.Blood transfusion with autologous and leukocyte depleted or standard allogeneic red blood cell and the immune responses to open heart surgery.Anesth Analg,2000,79:654
[19] Hanse E ,Wolff N,Knue chel R,et al.Tumor cell in blood shed from the surgical field.Arch Surg,1995,130(4):387-393
[20] 李大鹏,徐学芳,任红,等.自体输血在骨科手术中的应用.中国矫形外科杂志,2001,8(12):1240-1241
[21] 邱颐,金阿荣,高桂英,等.自体输血在骨科手术中的应用.内蒙古医学杂志,2001,33(2):143-145
[22] 周柏发,肖玉,刘风英.输血对脑膜瘤患者术后感染的影响观察.中国输血杂志,2001,14(3):141-142