摘要：
目的 观察合并糖尿病的骨科手术患者术中应用洗涤式自体血液回收后红细胞相关指标的变化和对红细胞回收率的影响. 方法 择期行骨科手术的患者70例,分为7组,每组10例.其中合并糖尿病者根据病史以及糖化血红蛋白(hemoglobin A1c,HbA1c)水平纳入如下6组:病史0～5年,HbA1c＜7％为A1组,HbA1c≥7％为A2组;病史6～10年,HbA1c＜7％为B1组,HbA1c≥7％为B2组;病史大于10年,HbA1c＜7％为C1组,HbAlc≥7％为C2组.无糖尿病者纳入对照组(D组).比较各组患者出血量、回收血量和红细胞回收率等.在术前(T0)、术中失血回收后洗涤前(T1)及术中失血洗涤后(T2)各取5 ml血液标本,检测红细胞相关指标和血气电解质. 结果 与D组比较,除A1组外其余各组BMI值均明显偏高,且A2组、B2组、C1组和C2组高于A1组,B2组和C2组高于B1组(P＜0.05).与D组比较,B2组和C2组红细胞回收率略低(P＜0.05).在T0时点,与D组和A1组比较,B2和C2组Hct、Hb和红细胞计数均降低,而同组患者在T0、T1和T2时点三指标均先降低后增高(P＜0.05).在T0时点,与D组比较,B2组、C1组和C2组红细胞平均体积(erythrocyte mean corpuscular volume,MCV)均增大,C2组大于A1组(P＜0.05).在T0时点,B2组和C2组平均红细胞血红蛋白含量(mean corpuscular hemoglobin content,MCH)和红细胞平均血红蛋白浓度(mean corpuscular hemoglobin concentration,MCHC)均高于D组和A1组;7组患者MCH均在T1增加,而在T2下降至T0水平;同组患者MCHC在T0、T1和T2时点之间差异有统计学意义(P＜0.05).T0与T1时点,与D组比较,A2组、B2组、C1组和C2组红细胞分布宽度(red blood cell distribution width,RDW)均增宽;与A1组比较,B2组和C2组RDW增宽(P＜0.05).与T0时点比较,各组血液标本pH和Na+值在T1和T2均显著上升(P＜0.05).而各组K+在T1均显著上升,在T2下降至低于T0水平(P＜0.05).各组患者T2时血液标本红细胞相关指标和pH、Na+以及K+差异均无统计学意义(P＞0.05). 结论 HbAlc控制不佳的糖尿病骨科手术患者经洗涤式自体血液回收后红细胞相关指标有改变,回收率降低,但可以安全回输.%Objective To explore the effect of intraoperative blood salvage on indexes of erythrocyte in orthopedic surgery of diabetic patients.Methods A total of 70 patients undergoing selective orthopaedics surgery were included in this study.They were divided into 7 groups with 10 patients each.Non-diabetes patients served as control group (group D).The others were divided into 6 groups according to the history of diabetes and the level of hemoglobin A1c(HbA1c).0 to 5 y diabetics whose HbA1c level ＜7％ were incorporated into group A1,while those whose HbA1c level ≥7％ belong to group A2,6 to 10 y diabetics were assigned into group B1 (HbA1c level ＜7％) and B2(≥7％).More than 10 years diabetics were incorporated into group C1(HbA1c level ＜7％) and C2(≥7％).The amount of bleeding,blood salvage and erythrocyte recovery rates were compared among the 7 groups.5 ml blood samples were drawn at three time points including preoperation(T0),after blood collection(T1) and washing(T2).Subsequently,blood gas analysis and erythrocyte related index were tested.Results Regarding BMI compared with group D,all the groups except A1 were significantly higher.The BMI of group A2,B2,C1 and C2 was higher than group A1 while that of group B2 and C2 higher than B1 (P＜0.05).The red blood cell recovery of group B2 and C2 dpressed as compared with control (P＜0.05).Hct,Hb and the red blood cell count of group B2 and C2 were lower than group D and A1 at T0.The three indicators above of all the same group were all reduced significantly at T1 and exceeded the level of T0 at T2 (P＜0.05).At T0,the erythrocyte mean corpuscular volume of group B2,C1 and C2 rised compared with group D,and goup C2 was higher than group A1(P＜0.05).The mean corpuscular hemoglobin content(MCH) and the mean corpuscular hemoglobin concentration (MCHC) of group B2 and C2 were significantly greater compared with group D and A1.The MCH of all the 7 groups was raised at T1 and reduced to the level of T0 at T2.There were statistical differences of MCHC in the same groups at the three time points.The red blood cell distribution width in group A2,B2,C1 and C2 were evidently broadened than group D at T0 and T1· And group B2 and C2 showed increased width compared with group A1 (P＜0.05).The levels of pH and Na+ of each group increased quite significantly at T1 and T2 as compared with T0(P＜0.05).The K+ concentrations of each group were increased significant at T1 and reduced below the level of T0 at T2 (P＜0.05).There was no difference among all the erythrocyte related index,pH,Na+ and K+ at T2.Conclusions The recovery rates of erythrocyte in diabetic patients whose HbA1c were poorly controlled were declined.But the salvaged blood could be retransfused safely.
