回收式自体输血对骨科患者血液流变学和免疫功能的影响

Influence of salvaged autotransfusion on hemorrheology and immune function in orthopedic patients

目的评估回收式自体输血对骨科患者血液流变学和免疫功能的影响及相应护理干预的效果。方法选择骨科就诊的患者67例,分为异体输血组(A组)和自体输血组(B组),分别为31例和36例。A组采用异体输血并常规护理,B组采用回收式自体输血加用预见性护理。输血前及输血后分别检查两组患者的血液流变学、免疫功能及护理效果。结果两组输血后红细胞计数、血细胞比容较输血前明显下降,差异有统计学意义(P<0.05)。比较输血后红细胞聚集性、红细胞刚性,两组输血后与输血前差异均无统计学意义(P>0.05),但B组红细胞聚集性较A组表现出下降趋势。A组异体输血后CD4+、CD4+/CD8+、NK细胞较术前明显下降,差异有统计学意义(P<0.05),CD8+较输血前明显增加,差异有统计学意义(P<0.05)。B组输血后与输血前无明显变化,差异无统计学意义(P>0.05)。比较两组输血后免疫功能变化,B组CD4+、CD4+/CD8+、NK细胞较A组明显增高(P<0.05),CD8+明显下降,差异有统计学意义(P<0.05)。B组采用循证护理及预见性护理后,术后并发症发生率明显降低,两组发生率差异有统计学意义(P<0.05)。结论回收式自体输血可维持血液流变学的稳定并维持正常免疫功能,配合预见性护理可减少并发症的发生。

Objective To evaluate the influence of salvaged autotransfusion on hemorrheology and irmnune function in orthopedic patients and the effects of corresponding nursing intervention. Methods 67 orthopedic patients in our hospital were selectred and divided into the allogeneic transfusion group（group A, 31 cases） and the salvaged autotransfusion group（group B,36 cases）. The group A adopted the allogeneic blood transfusion and routine care, while the group B accepted the salvaged autologous blood transfusion plus predictive care. The hemorrheology, im mune function and nursing effects in the two groups were checked before transfusion and after transfusion. Results Red blood celI（RBC） count and hematocrit after blood transfusion in the two groups were significantly decreased compared with before transfusion（P〈0.05）. RBC aggregation and erythrocyte rigidity in the two groups had no sta- tistical difference between before and after blood transfusion（P〉0.05）, but the erythrocyte rigidity in the group B showed the decreasing trend compared with the group A. CD4＋ , CD4＋/CD8＋ and NK ceils after allogeneic blood transfusion in the group A were significantly decreased than before transfusion（P〈0.05） ,CD8＋ was significantly in- creased than before transfusion（P〈0.05）. The group B had no obvious change between before and after transfuriou （P〉0.05）. Comparing the changes of the immune function in the two groups,CD4＋ ,CD4＋/ CD8＋ and NK ceils in the group B were significantly increased than the group A（P 〈0.05）, while CD8＋ was significantly decreased （P〈 0.05）. After adopting the evidence-based nursing and the predictive nursing in the group B, the occurrence rate of complications was significantly decreased, the difference between the two groups had statistical significnce （P〈 0.05）. Conclusion The salvaged autotransfusion can maintain the hemorrheological stability and normal immune function, which cooperated by the predictive nursing can reduce the complication occurrence.