肝移植术中自体血回收后乙肝失代偿患者红细胞功能的变化

The changes of erythrocyte function after intra-operative autotransfusion in decompensated patients with hepatitis B undergoing liver transplantation

目的探讨肝移植手术中自体血液回收对乙肝失代偿患者红细胞功能的影响。方法选择乙肝失代偿患者拟行原位肝移植手术者15名,术中用自体血液回收机做血液回收,采集术野及回收后血液各15 ml,分别检测红细胞形态、全血2,3-DPG、血浆游离血红蛋白(FHb)、红细胞渗透脆性、膜蛋白浓度、膜超微量ATP酶、丙二醛(MDA)等生理功能和血液流变学指标。结果自体血液回收后红细胞形态学积分增加,但回收前后差异无统计学意义(P>0.05);血液回收前后全血2,3-DPG、Na+K+-ATPase、Ca2+-ATPase、Mg2+-ATPase、MDA及渗透脆性无统计学意义(P>0.05),而FHb明显增多(回收前37.1±5.7mg/l,回收后50.7±12.6mg/l,P<0.05);术中回收后血液中切粘度(回收前5.64±2.35、回收后3.56±1.35,P<0.05)、高切粘度(回收前3.64±1.06、回收后2.33±0.7,P<0.05)明显降低,卡松粘度明显增高(回收前0.9±0.03、回收后1.7±0.62,P<0.05)。结论自体血回收后,行肝移植术的乙肝失代偿患者红细胞形态、结构、生理功能及流变学指标未见明显不良影响。

Objective To investigate the effects of intra-operative autotransfusion during liver transplantation on erythrocyte function in deeompensated patients with hepatitis B. Methods Fifteen decompensated patients with hepatitis B undergoing liver transplantation were chosen and intra-operative autotransfusion was performed. Erythrocyte morphology, 2,3- DPG, plasma free hemoglobin, osmotic fragility, ATP enzyme, MDA and hemorheology were detected. Results Erythrocyte morphology scores increased after autotransfusion. There was no significant change in 2,3-DPG, Na ^＋ K^＋ -ATPase, Ca^2＋ -ATPase, Mg^2＋ -ATPase, MDA and osmotic fragility （ P 〉 0.05 ） after autotransfusion, while plasma free hemoglobin increased [ from （37.1 ± 5.7 ） mg/l to （50.7 ± 12.6） mg/l, P 〈 0.05 ]. Some of the hemorheology indexes changed after autotransfusion（middle shear stress blood viscosity： from 5.64 ±2.35 to 3.56 ± 1.35, high shear stress blood viscosity： from 3.64 ± 1.06 to 2.33 ± 0.7, Casson viscosity ： from 0.9 ± 0.03 to 1.7 ± 0.62, P 〈 0.05）. Conclusion Erythroeyte morphology, physiological function and hemorheelogy in deeompensated patients with hepatitis B were not signifieandy affected by intra-operative autotransfusion in liver transplantation.