急性等容血液稀释联合快速康复外科措施对肝叶切除术患者免疫功能的影响

发布时间：2018-02-02 10:28

本文关键词： 急性等容血液稀释快速康复外科肝叶切除术免疫功能　出处：《实用医学杂志》2017年14期 　论文类型：期刊论文

【摘要】：目的观察急性等容血液稀释(ANH)联合快速康复外科(ERAS)对肝叶切除术患者的效果及免疫功能影响。方法肝叶切除术患者80例,随机分成:ANH+ERAS组(AE组)和对照组(C组)。均全麻下手术,C组常规输液;AE组行ANH,并应用ERAS。记录术中输液量、出血量、尿量及术后临床指标:排气及排便时间、进食全流质及住院时间。于麻醉诱导前(T_1)、术毕即刻(T_2)、术后1(T_3)、3(T_4)、7 d(T_5)抽血检测:CD4~+,CD8~+,CD4~+/CD8~+,NK cell水平。结果与T0比较,E组T_(2-3)时点CD3~+、CD4~+及NK细胞指标下降,CD8上升。与E组比较,AE组无输异体血病例;术后临床指标时间均缩短;T_(2-3)时点CD3~+、CD4~+、CD4~+/CD8~+及NK细胞升高,CD8~+降低,差异有统计学意义(P0.05)。结论 ANH复合ERAS可减少肝叶切除术患者输注异体血,减轻对免疫功能的抑制,缩短术后住院时间等,值得临床推广。
[Abstract]:Objective to observe the effect of acute isovolumetric hemodilution (ANH) combined with rapid rehabilitation surgery (ERASS) on hepatectomy and its immune function. They were randomly divided into two groups: the control group (group C) and the control group (group A). Group C was given routine infusion under general anesthesia. ANHs were used in AE group and ERAS.Intraoperative infusion volume, blood loss, urine volume and postoperative clinical indexes: exhaust and defecation time, total fluid intake and hospitalization time were recorded before anesthesia induction. At the end of the operation, T2 was put in place immediately after the operation. After the operation, 1 T3 + T + 3 / T + 3 / T / T / T / T / T / T were collected for 7 days.) the blood samples were taken to detect CD8 ~ / CD8 ~ / CD4 ~ / CD8 ~ + / CD4 ~ / CD8 ~. Results compared with T _ 0, CD _ 3 ~ T _ 4 ~ and NK cell index decreased and CD8 increased in E group. No allogeneic blood transfusion was found in AE group. The time of clinical indexes was shortened after operation. The levels of CD4 ~ / CD8 ~ and NK cells increased and CD8 ~ decreased at the time point of T _ (2 ~ 3). Conclusion ANH combined with ERAS can reduce the transfusion of allogeneic blood, reduce the inhibition of immune function and shorten the postoperative hospital stay in patients undergoing hepatectomy. It is worth popularizing in clinic.
【作者单位】：中山大学附属佛山医院麻醉科;中山大学附属佛山医院肝脏外科;
【基金】：广东省临床重点专科建设资金资助项目(编号:粤卫(2011)144) 佛山市医学类科技攻关项目(编号:2015AB00301)
【分类号】：R614
【正文快照】： 如何减少术中出血及输异体血,是临床关注的问题。其中急性等容血液稀释(acute normovolemic he-modilutio,ANH)是一种操作简便、经济实用的血液保护措施,可提供新鲜自体血液回输,减少异体血输注[1-3]。而患者术后康复也是热点问题,快速康复外科(enhanced recovery after surge

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