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

摘要

目的：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。方法将60例脊柱外科手术患者，随机分为对照组、自体血回输组、急性等容量血液稀释组，每组20例。对照组在术中出血多时就输入异体库存血。自体血回输组在术中联合使用自体血回收装置，血红蛋白低下时就输库存血。急性等容量血液稀释组先经外周静脉输入一定晶体液或胶体液，再经颈内静脉缓慢的抽出机体血液装入专用的含有抗凝的血袋内，经血液摇摆机不停地摇动，适当的时候输入。术前（T1）、术后2 h（T2）、6 h（T3）、12 h（T4）及24 h（T5）各时间点抽血5 mL ，检测白细胞（WBC）、白细胞介素‐6（IL‐6）、肿瘤坏死因子‐α（TNF‐α）水平，记录术后有无并发症。结果自体血回输组和急性等容量血液稀释组回收血WBC计数均高于 T1检测结果，差异有统计学意义（P＜0．05）；3组患者在T2～T5时间点血清IL‐6、TNF‐α及WBC水平与T1时间点检测结果比较显著增高，但均明显低于对照组，差异有统计学意义（P＜0．05）；术后随访无一例并发症。结论自体血回输组和急性等容量血液稀释组可以有效降低术中及术后全身炎症反应，明显节约血资源。%Objective To investigate the effects of autologous blood transfusion and acute normovolemic hemodilution inflamma‐tory response in patients with spinal surgery .Methods 60 patients with spinal surgery ,were randomly divided into the control group ,autologous blood transfusion group ,acute normovolemic hemodilution group ,20 cases in each group .The control group in in‐traoperative bleeding time and blood input variants of inventory .Autologous blood transfusion group was used in combination with intraoperative autologous blood recovery unit ,lose banked blood hemoglobin was low .Acute normovolemic hemodilution group via peripheral vein input must first crystal liquid or gel liquid ,then through internal jugular vein slowly pulled out the body′s blood into the special bags containing anticoagulant ,swing machine through blood kept shaking ,input when appropriate .Preoperative(T1) , After surgery 2 h(T2) ,6 h(T3) ,12 h(T4) and 24 h(T5) blood at each time point 5 mL ,detect the WBC ,IL‐6 ,TNF‐α.Records with and without postoperative complications .Results WBC in autologous blood transfusion group and acute normovolemic he‐modilution group were higher than that of preoperative ,difference was statistically significant(P<0 .05);In T2 -T5 ,serum IL‐6 , TNF‐a and the WBC concentration compared with the basis of their respective value(T1) increased significantly ,but were signifi‐cantly lower than control group ,the difference was statistically significant(P< 0 .05) .Postoperative follow‐up of the autologous blood transfusion group and acute normovolemic hemodilution group and no complications .Conclusion The autologous blood trans‐fusion group and acute normovolemic hemodilution group could effectively reduce the intraoperative and postoperative systemic in‐flammatory response ,which obviously save blood resources .