白细胞滤器对体外循环剩余机血成分及炎性细胞因子影响的随机对照研究

Effects of Leukocyte Filtration on Blood Components and Cytokines of Residual Pump Blood after Cardiopulmonary Bypass: A Randomized Controlled Trial

目的 探讨白细胞滤器对体外循环剩余机血成分及炎性细胞因子的影响。 方法 选取2012年12月至2013年2月中国医学科学院阜外心血管病医院体外循环下择期心脏手术患者40例，其中男34例、女6例，年龄16～72岁。将患者随机均分为试验组和对照组。试验组将剩余机血通过白细胞滤器过滤后储存于无菌储血袋中待回输，对照组在体外循环结束后将剩余机血储存于无菌储血袋中待回输。分别采集患者体外循环转机前动脉血（T1）、停机后剩余机血（T2）、室温放置4 h剩余机血（T3）各20 ml，测定血液中成分及血浆中白细胞介素6 （IL-6）、IL-10和肿瘤坏死因子α（TNF-α）的浓度。 结果 T2及T3时试验组白细胞及中性粒细胞计数明显低于对照组（P＜0.05），红细胞计数、血红蛋白、红细胞压积、游离血红蛋白同时间点组间差异无统计学意义（P＞0.05）。两组患者血浆中IL-6、IL-10和TNF-α浓度各时间点组内差异无统计学意义（P＞0.05），同时间点组间差异无统计学意义（P＞0.05）。 结论 采用白细胞滤器滤过体外循环剩余机血可以减少余血中的白细胞数量，对剩余机血中其他成分及血浆中炎性细胞因子含量无明显影响。

Objective To evaluate the effects of leukocyte filtration （LF） on blood components and cytokines ofresidual pump blood after cardiopulmonary bypass （CPB）. Methods Forty patients who underwent selective cardiac surgery with CPB in Fu wai Hospital from December 2012 to February 2013 were included in this study. There were 34 male and 6 female patients with their age of 16-72 years. All the patients were randomly divided into an experimental group and a control group. In the experimental group, patients received residual pump blood transfusion which had been processed with LF and stored in sterile blood collection bags. In the control group, patients received residual pump blood transfusionwhich was stored in sterile blood collection bags without LF process after CPB. Blood samples were taken before CPB （T1）,at the end of CPB （T2） and 4 hours （T3） after CPB to examine blood components and concentrations of IL-6,IL-10 and TNF-α. Results White blood cell count and neutrophil count of the experimental group were significantlylower than those of the control group at T2 and T3 （P〈0.05）. There was no statistical difference in red blood cell count,hemoglobin,hematocrit or free hemoglobin at respective time points between the 2 groups （P〉0.05）. There was no statisticaldifference in plasma IL-6,IL-10 or TNF-α concentrations at different time points within either group （P〉0.05）,or atrespective time points between the 2 groups （P〉0.05）. Conclusion LF can reduce white blood cell count and neutrophilcount of residual pump blood,but does not significantly change other blood components and plasma concentrations of IL-6,IL-10 or TNF-α after CPB.