回收式自体输血对骨科手术患者凝血及免疫功能的影响

Effect of autotransfusion on blood coagulation and immune function in patients undergoing orthopedic surgery

目的探讨回收式自体输血对机体凝血状态和T淋巴细胞亚群,NK细胞功能的影响。方法选择骨科大手术病人40例,随机分为回收式自体输血组和异体输血组。分别取术前、输血后1h及输血后24h的静脉血,测定血常规,部分凝血酶原时间(APTT),凝血酶原时间(PT),纤维蛋白原(FIB)及活化凝血时间(ACT),同时应用流式细胞仪测定输血后第1天、第5天两组病人T淋巴细胞亚群CD3+、CD4+、CD8+、自然杀伤细胞(NK细胞),并计算CD4+/CD8+值。结果输血后1h两组APTT、PT、ACT均延长,FIB和血小板计数均降低(P<0.05)但尚在正常范围内,两组间比较差异无显著性(P>0.05)。与术前比较,异体输血组输血后第1天和第5天CD3+、CD4+、NK细胞数量显著减少(P<0.01),回收式自体输血组上述指标无明显变化(P>0.05)。结论回收式自体输血对凝血功能的影响与异体输血相似,回收式自体输血对机体细胞免疫功能无明显抑制作用。

[Objective] To investigate the changes in blood coagulation and T-Lymphocyte subset and natural killer cell after blood salvage and homologous blood transfusion. [Methods] 40 patients undergoing elective orthopedic surgery were randomly divided into 2 groups： blood salvage group and homologous blood transfusion group. At preoperative, 1 h and 24 h after blood transfusion, platelets, PT, APTF, FIB and ACT were measured. On 1st and 5th.postoperation for determination of T-lymphocyte subsets and natural killer cell counts by flow cytometry and account CD4^＋/CD8^＋. [Results] After blood transfusion, APTF, PT, ACT prolonged significantly, FIB and platelets decreased in these groups （P 〈0.05）, There was no significant difference between the two groups. In homologous blood transfusion group, the number of CD3^＋, CD4^＋, CD4^＋/CD8^＋, NK cell was decreased obvious on 1st and 5th postoperation when compared with preoperation （P 〈0.01）. But in the bood salvage group, the changes of CD3^＋, CD4^＋, CD4^＋/CD8^＋, NK cell were unsignificant. [Conclusion] Intraoperative blood salvage and reinfusion does not induce significant change of blood coagulation as compared with allogenic blood trasfusion. The influence of blood salvage and retransfusion on immune function is slight.