术中自体血液回输对患者全身炎症反应的影响及其防治
发布时间：2019-05-03 18:17
【摘要】：背景：围术期血液丢失是外科手术的一个主要问题。围术期失血可以导致术后血红蛋白降低,其传统的治疗方法是同种异体输血。尽管做了很多努力来改进异体血的质量,但是异体输血的风险依然很大。除了众所周知的传染病的传播、输血相关发热反应、输血相关急性肺损伤等风险外,人们还关注异体输血与免疫调节的因果关系。输血可以导致机体免疫系统受到抑制,从而增加术后感染、伤口延迟愈合的发生率,并最终使住院时间延长。 异体输血的替代方法包括术前自体贮血、术中急性等容血液稀释、术中自体血液和术后引流血液的回收和回输等。其中,术中自体血回收是一种重要的血液保护措施,可以有效减少异体血需求和相关并发症。但目前常规的洗涤、过滤方法不能彻底去除自体血中的白细胞,从而导致活化的白细胞、细胞因子和其它的小颗粒凝聚物混杂其中。上述自体血回输后可以加重患者术后全身炎症反应程度,可以在一定程度上影响患者的临床结局。在自体血回输前加用自体血液过滤器可能是减轻以上不良反应的一种有效方法。 目的：观察术中自体血回输对患者全身炎症反应的影响,比较使用自体血液过滤器是否可以减轻回输自体血导致的全身炎症反应。 材料与方法：选取全麻下行脊柱侧弯后路矫形内固定手术患者30例,根据计算机随机数字表随机分为对照组(Cell Saver5+处理后的自体血直接回输)和实验组(Cell Saver5+处理后的自体血经Pall LipiGuard SB1型血液过滤器过滤后回输)各15例。分别取术前体内血、回收自体血、洗涤自体血、过滤自体血(限实验组)、回输前体内血、回输后2h体内血、回输后24h体内血及回输后72h体内血各5ml,分别检测血常规、IL-6、IL-10和NE的水平。记录患者术后恢复和并发症发生情况。 统计学处理：所有数据用均数±标准差或中位数(25%分位数,75%分位数)进行描述,使用SAS9.2统计软件利用广义线性混合模型(Genaralized linear mixed model)对组内和组间的差异进行检验。 结果：两组回收血白细胞计数均高于术前(P0.001),洗涤和过滤后下降(P0.001)。实验组过滤血中性粒细胞百分比低于洗涤血(P=0.013)。实验组IL-6水平低于对照组(p=0.001)。实验组未发现术后并发症,对照组出现术后伤口液化和肺部感染各1例。 结论：自体血液过滤器用于术中自体血回输可以有效降低自体血中的白细胞数量、中性粒细胞百分比和IL-6的水平,从而减轻患者术后全身炎症反应程度。
[Abstract]:Background: perioperative blood loss is a major problem in surgery. Perioperative blood loss can lead to postoperative hemoglobin reduction, the traditional treatment is allogeneic blood transfusion. Despite efforts to improve the quality of allogeneic blood, the risk of allogeneic blood transfusion remains high. In addition to the well-known risk of transmission of infectious diseases, transfusion-related fever, transfusion-related acute lung injury, there is also concern about the causal relationship between allogeneic transfusion and immunomodulation. Blood transfusion can inhibit the immune system, increase the incidence of postoperative infection and delayed wound healing, and ultimately prolong the hospital stay. Alternative methods of allogeneic blood transfusion include preoperative autologous blood storage, intraoperative acute isovolemic hemodilution, intraoperative autogenous blood and postoperative drainage blood recovery and re-transfusion. Among them, autologous blood recovery during operation is an important blood protection measure, which can effectively reduce the demand for allogeneic blood and related complications. However, the conventional washing and filtration methods can not completely remove white blood cells from autogenous blood, which leads to the mixture of activated leukocytes, cytokines and other small particle aggregates. The above autotransfusion can aggravate the postoperative systemic inflammatory reaction and affect the clinical outcome of the patients to a certain extent. The use of autogenous blood filter before autotransfusion may be an effective way to reduce the adverse reactions mentioned above. Aim: to observe the effect of intraoperative autotransfusion of autologous blood on systemic inflammatory response and to compare the effect of autologous blood filter on systemic inflammatory response induced by transfusion of autologous blood. Materials and methods: 30 patients undergoing posterior correction and internal fixation of scoliosis under general anesthesia were selected. According to the computer random digital table, 15 cases were randomly divided into two groups: control group (Cell Saver5-treated autotransfusion) and experimental group (Cell Saver5-treated autologous blood was filtered by Pall LipiGuard-SB1 blood filter and re-injected). The blood before operation was collected, the autogenous blood was washed, the autogenous blood was filtered (limited to the experimental group), the blood in the body before transfusion, the blood in vivo 2 hours after transfusion, the blood in vivo 24 hours after transfusion and the blood in body 72 hours after transfusion were measured respectively, and the blood routine was measured respectively. IL-6,IL-10 and NE levels. Postoperative recovery and complications were recorded. Statistical processing: all data are described by mean 卤standard deviation or median (25% quartile, 75% quartile). SAS9.2 statistical software was used to test the intra-group and inter-group differences using the generalized linear mixed model (Genaralized linear mixed model). Results: the WBC counts in both groups were higher than those before operation (P0.001), and decreased after washing and filtering (P0.001). The percentage of neutrophils in the filtered blood of the experimental group was lower than that of the washed blood (P < 0. 013). The level of IL-6 in experimental group was lower than that in control group (p < 0. 001). No postoperative complications were found in the experimental group, 1 case of wound liquefaction and 1 case of pulmonary infection in the control group. Conclusion: autologous blood filter can effectively reduce the number of leukocytes, the percentage of neutrophil and the level of IL-6 in autologous blood, which can reduce the degree of systemic inflammatory reaction after operation.
【学位授予单位】：北京协和医学院
【学位级别】：博士
【学位授予年份】：2013
【分类号】：R614
本文编号：2469140
[Abstract]:Background: perioperative blood loss is a major problem in surgery. Perioperative blood loss can lead to postoperative hemoglobin reduction, the traditional treatment is allogeneic blood transfusion. Despite efforts to improve the quality of allogeneic blood, the risk of allogeneic blood transfusion remains high. In addition to the well-known risk of transmission of infectious diseases, transfusion-related fever, transfusion-related acute lung injury, there is also concern about the causal relationship between allogeneic transfusion and immunomodulation. Blood transfusion can inhibit the immune system, increase the incidence of postoperative infection and delayed wound healing, and ultimately prolong the hospital stay. Alternative methods of allogeneic blood transfusion include preoperative autologous blood storage, intraoperative acute isovolemic hemodilution, intraoperative autogenous blood and postoperative drainage blood recovery and re-transfusion. Among them, autologous blood recovery during operation is an important blood protection measure, which can effectively reduce the demand for allogeneic blood and related complications. However, the conventional washing and filtration methods can not completely remove white blood cells from autogenous blood, which leads to the mixture of activated leukocytes, cytokines and other small particle aggregates. The above autotransfusion can aggravate the postoperative systemic inflammatory reaction and affect the clinical outcome of the patients to a certain extent. The use of autogenous blood filter before autotransfusion may be an effective way to reduce the adverse reactions mentioned above. Aim: to observe the effect of intraoperative autotransfusion of autologous blood on systemic inflammatory response and to compare the effect of autologous blood filter on systemic inflammatory response induced by transfusion of autologous blood. Materials and methods: 30 patients undergoing posterior correction and internal fixation of scoliosis under general anesthesia were selected. According to the computer random digital table, 15 cases were randomly divided into two groups: control group (Cell Saver5-treated autotransfusion) and experimental group (Cell Saver5-treated autologous blood was filtered by Pall LipiGuard-SB1 blood filter and re-injected). The blood before operation was collected, the autogenous blood was washed, the autogenous blood was filtered (limited to the experimental group), the blood in the body before transfusion, the blood in vivo 2 hours after transfusion, the blood in vivo 24 hours after transfusion and the blood in body 72 hours after transfusion were measured respectively, and the blood routine was measured respectively. IL-6,IL-10 and NE levels. Postoperative recovery and complications were recorded. Statistical processing: all data are described by mean 卤standard deviation or median (25% quartile, 75% quartile). SAS9.2 statistical software was used to test the intra-group and inter-group differences using the generalized linear mixed model (Genaralized linear mixed model). Results: the WBC counts in both groups were higher than those before operation (P0.001), and decreased after washing and filtering (P0.001). The percentage of neutrophils in the filtered blood of the experimental group was lower than that of the washed blood (P < 0. 013). The level of IL-6 in experimental group was lower than that in control group (p < 0. 001). No postoperative complications were found in the experimental group, 1 case of wound liquefaction and 1 case of pulmonary infection in the control group. Conclusion: autologous blood filter can effectively reduce the number of leukocytes, the percentage of neutrophil and the level of IL-6 in autologous blood, which can reduce the degree of systemic inflammatory reaction after operation.
【学位授予单位】：北京协和医学院
【学位级别】：博士
【学位授予年份】：2013
【分类号】：R614
【参考文献】
相关期刊论文 前1条
1 李景文;龙村;孙鹏;刘凯;考力;;经白细胞滤器过滤后的体外循环余血回输对患者炎性细胞因子的影响[J];中国体外循环杂志;2010年02期
，本文编号：2469140
本文链接：https://www.wllwen.com/yixuelunwen/jjyx/2469140.html
最近更新
教材专著
