滤除白细胞对白体回收血诱发大出血手术患者全身炎性反应的影响

Effects of leukocyte depletion on systemic inflammatory response induced by intraoperative salvaged blood in patients undergoing major operation with massive bleeding

目的评价滤除白细胞对自体回收血诱发大出血手术患者全身炎性反应的影响。方法选择预计大出血手术需进行自体血液回输患者24例，年龄28～56岁，体重53～78kg，随机分为2组（n=12）：对照组（C组）和白细胞滤除组（T组）。C组不使用白细胞过滤器，T组于泵后串联LG6型白细胞过滤器，分别于自体血回输前即刻、回输后5、10、30、60min时抽取桡动脉血3ml，测定血浆肿瘤坏死因子（TNF）-α、白细胞介素（IL）-6和IL-8的浓度，计数白细胞（WBC）和中性粒细胞（PMN）。结果与自体血回输前即刻比较，自体血回输后各时点两组血浆TNF—α、IL-6、IL-8的浓度及WBC和PMN计数均升高（P〈0．05）；与c组比较，T组于自体血回输后各时点WBC和PMN计数降低，血浆TNF-α、IL-6、IL-8浓度降低（P〈0．05）。结论滤除白细胞可减轻自体回收血诱发大出血手术患者全身炎性反应的程度。

Objective To investigate the effects of reinfusion of leukocyte depletion on systemic inflammatory response induced by intraoperative salvaged blood in patients undergoing major operation with massive bleeding. Methods Twenty-four patients undergoing major operation expected to cause massive bleeding during operation including large liver hemangioma and closed liver and spleen rupture were randomly divided into 2 groups （n = 12 each）： control group （C） and leukocyte depletion group （T）. Anesthesia was induced with midazolam, fentanyl, propofol and succinyl choline and maintained with isoflurane inhalation and intermittent iv boluses of fentanyl and vecuronium. The patients were mechanically ventilated after tracheal intubation （VT = 8-10 ml/kg, RR= 12 bpm, I：E = 1：2）. Radial artery and right interval jugular vein were cannulated for continuous BP and CVP monitoring and blood sampling. Intraoperative blood salvage and reinfusion were performed in all patients using cell saver system （Type ZT-2000, Beijing China）. In group T the salvaged blood was tittered with a leukocyte depleting filter （type LG6 Pall Co. USA） placed in the line of the reinfusion circuit. Blood samples were taken from radial artery immediately before the shed blood was reinfused （baseline） and at 5, 10, 30 and 60 min after reinfusion for determination of plasma concentration of TNF-α, IL-6, IL-8, neutrophil and total leukocyte count. Results The two groups were comparable with respect to age, M/F sex ratio, body weight, intraoperative blood loss and the amount of salvaged blood reinfused. The plasma TNF-α, IL-6 and IL-8 concentrations, and WBC and PMN count were significantly increased as compared the baseline values in both groups and were significantly lower in group T than in group C. Conclusion Leukocyte depletion can reduce the degree of the systemic inflammatory response induced by reinfusion of intraoperative salvaged blood in patients undergoing major operation with massive bleeding.