回收式自体输血与异体输血对凝血功能、免疫功能及炎症因子的影响

摘要

目的:研究回收式自体输血与异体输血对凝血功能、免疫功能及炎症因子的影响.方法:选择74例患者作为研究对象,并随机分为自体组和异体组,每组各37例.自体组患者接受回收式自体输血;异体组接受异体输血.术后1 d和术后5 d时,测定两组患者的凝血功能指标、免疫功能指标及炎症反应指标.结果:术后1 d和术后5 d时,自体组患者APTT、TT、PT水平及D-D、FDP含量与异体组比较无明显差异;两组患者外周血中CD3 +CD4 +T细胞、CD3 +CD8 +T细胞、CD16 +CD56 +NK细胞的含量均低于手术前,TLR2 +细胞、TLR4 +细胞的含量以及血清中sCD40L、CINC-1、TNF-α、IL-6的含量均高于手术前且自体组患者外周血中CD3 +CD4 +T细胞、CD3 +CD8 +T细胞、CD16 +CD56 +NK细胞的含量显著高于异体组,外周血中TLR2 +细胞、TLR4 +细胞的含量以及血清中sCD40L、CINC-1、TNF-α、IL-6的含量显著低于异体组.结论:回收式自体输血在不影响凝血功能的基础上改善免疫功能、抑制炎症反应.%Objective:To study the influence of intraoperative autotransfusion and allogeneic transfusion on coagulation function, immune function and inflammatory factors in patients with cardiac surgery.Methods:74 patients undergoing cardiac surgery in hospital between June 2014 and February 2017 were selected as the research subjects and randomly divided into two groups,autologous group re-ceived intraoperative autotransfusion and allogeneic group received allogeneic transfusion.The blood coagulation function indexes,im-mune function indexes and inflammatory response indexes of the two groups were measured 1 day and 5 days after surgery.Results:1 day and 5 days after surgery,APTT,TTnd PT levels as well as D-D and FDP contents of autologous group were not significantly different from those of allogeneic group.1 day and 5 days after surgery,peripheral blood CD3 +CD4 +T cell,CD3 +CD8 +T cell and CD16 +CD56 +NK cell contents were lower than those before surgery,peripheral blood TLR2 +cell and TLR4 +cell contents as well as serum sCD40L,CINC-1,TNF-α and IL-6 contents were higher than those before surgery and peripheral blood CD3 +CD4 +T cell,CD3 +CD8 +T cell and CD16 +CD56 +NK cell contents were greatly higher than those of allogeneic group,and peripheral blood TLR2 +cell and TLR4 +cell contents as well as serum sCD40L,CINC-1,TNF-α and IL-6 contents were greatly lower than those of allogeneic group. Conclusion:Intraoperative autotransfusion for cardiac surgery can improve the immune function and inhibit the inflammatory response without affecting the coagulation function.