自体输血与同种输血对骨科患者术后恢复的影响

Effect of Autotransfusion and Homologous Transfusion on Postoperative Recovery of Orthopedic Patients

为研究自体输血与同种输血对骨科患者免疫功能、血液氧合代谢水平变化影响,本研究选取骨科手术需要输血的患者98例,根据随机数字法分为对照组和观察组。对照组患者采用单纯输注异体血,观察组患者采用自体血液回输,通过检测患者免疫功能、血液氧合代谢、丙二醛(MDA)、细胞间粘连分子-1(ICAM-1)及基质金属蛋白酶-9(MMP-9)水平的变化,评估两组患者的治疗疗效。研究发现,术前两组患者混合静脉血氧饱和度、氧摄取率及动、静脉乳酸量、MDA、ICAM-1及MMP-9水平比较无统计学差异(p>0.05)。术后24h,观察组患者氧摄取率和动、静脉乳酸量、MDA、ICAM-1及MMP-9水平均低于对照组,两组患者混合静脉血氧饱和度比较无统计学差异(p>0.05)。术前,两组患者CD3^+、CD4^+、CD4^+/CD8^+、NK水平比较无统计学差异(p>0.05)。术后7d,观察组患者免疫功能水平均优于对照组(p<0.05)。两组患者术前、术后7d红细胞计数、血细胞比容、血红蛋白水平比较无统计学差异(p>0.05)。本研究的结果说明,自体输血对骨科术中出血量较大的患者,可以维持机体有效循环,避免机体免疫功能受损,减轻机体炎症反应,具有较好的临床应用价值。

To analyze the effect of autologous blood transfusion and allogeneic blood transfusion on immune function and blood oxygenation metabolism of orthopedic patients, 98 patients who needed blood transfusion in orthopedic surgery were divided into the control group and the observation group according to the random number method. The patients in the control group were treated by simple allogeneic blood transfusion, while the patients in the observation group were treated by autologous blood transfusion. The treatment efficacy of the two groups was analyzed as well as the effect on the immune function, blood oxygenation metabolism, malondialdehyde (MDA), intercellular adhesion molecule-1 (ICAM-1) and matrix metalloproteinase-9 (MMP-9) of patients. The results showed that before operation, there were no statistical difference between the two groups in the level of mixed venous oxygen saturation, oxygen uptake rate, the amount of lactic acid in vein, MDA, ICAM-1 and MMP-9 (p>0.05). 24 h after operation, the level of oxygen uptake rate, the amount of lactic acid in vein, MDA, ICAM-1 and MMP-9 in the observation group were lower than those in the control group. While, there was no statistical difference in mixed venous oxygen saturation between the two groups (p>0.05). Before surgery, the two groups had no significant difference on the level of CD3^+, CD4^+, CD4^+/CD8^+, and NK (p>0.05). 7 d after surgery, the immune function ofpatients in the observation group were better than that in the control group (p<0.05). Before operation and 7 d after operation, there was no significant difference on erythrocyte count, hematocrit and hemoglobin level between the two groups (p >0.05). The results indicated that autologous blood transfusion could help to maintain the effective circulation of the body, avoid the damage of immune function and reduce the inflammatory response of orthopedic patients with large amount of blood loss, which might have a good clinical application value.