洗涤回收式自体输血对腹部创伤患者细胞免疫的影响

摘要

目的:探讨洗涤回收式自体输血对腹部创伤患者细胞免疫的影响.方法:2006年6月—2011年5月收治需手术治疗并输血的腹部创伤患者共386名.应用随机数字法将患者分为2组,每组193例.研究组采用洗涤回收式自体输血,对照组用同种异体输血.记录腹部创伤患者急救期的回收血量、洗涤血量和回输血量,分别监测其输血前、输血后1h及输血后24 h生命体征和凝血功能指标的动态变化;输血前、输血后24 h及输血后5dT细胞亚群和细胞因子的变化.结果:研究组193例患者腹腔内积血和术中出血全部回收和回输成功,患者术中平均回收血量(2196±620)mL,平均洗涤红细胞悬液量(5172±615)mL,回收率为89.3％.对照组193例患者输血量400～2200 mL,平均(910+276)mL.2组患者术中和术后生命体征平稳,研究组和对照组各项监护指标值的组间差异无统计学意义(P＞0.05).术后对照组CD8+、CD4+/CD8+显著减少,研究组CD8+、CD4+/CD8+也有所减少,但减少幅度小于对照组,组间差异有统计学意义(P＜0.05).术后2组患者IL-6、IL-8均升高,但研究组与术前比差异有显著性,对照组与术前相比较差异无统计学意义(P＞0.05).术后2组患者IL-6、IL-8组间差异有统计学意义(P＜0.05).结论:洗涤回收式自体输血对腹部创伤患者免疫功能影响小,值得临床进一步研究并推广.%Objective: To explore the influence on autologous transfusion salvage on cellular immune function in patients with abdominal trauma. Methods:From June 2006 to may 2011, there were 386 abdominal trauma patients required surgical treatment and blood transfusions. Using random number method, these patients were divided into two groups, each group was 193. Study group was used autologous transfusion salvage and control group with allogeneic blood transfusion. Patients of abdominal trauma were recorded collecting, washing and recycling blood volume, monitored the vital signs and the dynamic changes in blood coagulation function at pre-transfusion1 hour、after transfusion 1 hour and 24 hours. Then we recorded the changes of T cell subsets and cytokine in pre- transfusion, after transfusion 24 hours and 5 days. Results: It was successful for autotransfu-sion group ,193 patients, to collect and wash abdominal hematocele and intraoperative blood. Among these patients , an average of recycled blood volume was (2 196 ± 620)mL, the red blood cells fluid was(5 172 ± 615)mL The recycled rate was 89.3%. In allogeneic transfusion group, the most transfusion volume of 193 patients was between 400 mL and 2 200 mL The average was (910 ± 276) mL There was no significant difference between the two groups in each monitoring index. Vital signs of the two groups were smooth in intraoperation and postoperation. CD8+ and CD4+/CD8+ of the control group were significantly reduced after postoperation. The study group was also reduced , but the decreasing rate was lesser than the control group. There were statistically significant differences between the two groups.IL-6、 IL-8 were increased in the two groups of patients, but compared with preoperation, it was significant difference in the study group, which showed no statistica difference in the two groups. After operation, it was statistical differences on IL-6 and IL-8 between the two groups of patients. Conclusion: The effect of immune function with abdominal trauma patients is little by Autologous transfusion salvage . It is worth for further research and promotion in clinic.