乌司他丁对术中自体血回收血内活化血小板和白细胞的影响

Effects of ulinastatin on activated leukocytes and platelets during intraoperative autotransfusion

目的探讨乌司他丁对术中自体回收血内血小板及白细胞活化程度的影响。方法随机选择ASAⅠ-Ⅲ级,年龄35～60岁,接受脊柱手术的病人40例,其中男性26例,女性14例。所有病人均按标准程序进行术中自体血回收,随机分为乌司他丁组(A组)和对照组(B组)各20例。A组于手术开始前给予乌司他丁5000 U/kg,以Facscalibur型流式细胞仪对回收血内及回输自体血前后体内血的血小板和白细胞进行检测。结果自体回收血内含有一定量的血小板和白细胞并且其活化程度显著高于体内血(P<0.05),使用乌司他丁后自体回收血内血小板和白细胞的活化程度明显降低(P<0.05),自体血回输后患者体内血小板和白细胞的活化程度显著增高且以B组更为明显(P<0.05)。结论乌司他丁可抑制血液回收过程中血小板和白细胞的激活,减轻活化血小板和白细胞回输后对机体的不良作用。

Objective To observe the effect of ulinastatin on activated leukocytes and platelets during intraoperative autotransfusion. Methods Forty patients aged 35 to 60 years old, scheduled for selective orthopedic surgery were randomly divided into ulinastatin group （Group A, 20 cases）and the control group （Group B, 20 cases）. Ulinastatin （5000 U/kg doses） were administered in A group before operation. Intraoperative autotransfusion were performed according to the standard procedure with all patients during operation. The activation of leukocytes and platelets in salvaged blood and in vivo after transfusion of salvaged blood were tested by flow cytometer.Results Leukocytes and platelets were activated during intraoperative autotransfusion. Percentages of the activated platelets and CDllb expression on leukocytes were significantly higher than those in vivo （P〈0.05）; in group B, percentages of the activated platelets and CDllb expression on leukocytes were significantly higher than in group A; activation of platelets and leukocytes were more significantly higher after salvaged blood transfusion but significantly lower in group A than in group B （P〈0.05）. Conclusions Using ulinastatin can inhibited or alleviated the activation of leukocytes and platelets during intraoperative conservation and decreased the harmful effects of salvaged blood, combined using ulinastatin and intraoperative autotransfusion can play an active effect on blood conservation.