不同保存液对体外循环剩余机血保护效果研究

The role of red cell storage solution and blood storage solution in preserving residual blood after cardiopulmonary bypass

目的比较血液保存液、红细胞保存液保存体外循环心内直视手术后剩余机血效果差异,为临床上体外循环后机血保存提供新的思路。方法收集体外循环心脏手术的成人患者剩余机血样本60例,每例机血样本抽取3份,随机纳入血液保存液组(n=60)、红细胞保存液组(n=60)、对照组(n=60)。分别于停机即刻、常温放置30 min、1 h、3 h、6 h、24 h时间点,测量钾离子(K+)、葡萄糖(Glu)及乳酸(Lac)数值。结果对照组剩余机血随放置时间延长,K+、Lac含量逐渐升高,Glu含量逐渐降低。血液保存液组或红细胞保存液组30 min后,K+含量比停机时明显下降(P <0.01),而后逐渐上升,但24 h内各时间点均显著低于对照组(P <0.01); 30 min时Glu含量比停机时显著上升(P <0.01),而后逐渐下降,但24 h内各时间点均显著高于对照组(P <0.01)。Lac含量均随放置时间延长逐渐升高,但三组上升速度有显著差异(P <0.05)。血液保存液组24 h Lac含量显著低于对照组(P <0.05)。结论用血液保存液或红细胞保存液保存剩余机血并不是理想方法。

Objective To investigate different roles of red cell storage solution and blood storage solution in preserving residual blood after cardiopulmonary bypass (CPB) in cardiac surgery.Methods A total of 60 blood samples were collected after cardiopulmonary bypass and each sample was divided into three groups according to different preservation methods,namely blood storage solution group,red cell storage solution group and control group.Blood gas analysis was conducted at different time points under room temperature: instant discontinuation of CPB (T1),30 min after CPB (T2),1 h after CPB (T3),3 h after CPB (T4),6 h after CPB (T5),and 24 h after CPB (T6).Potassium (K^+)、glucose (Glu) and lactate (Lac) levels were specifically analyzed. Results In control group,levels of K^+ and Lac in residual blood increased gradually with time,while Glu levels decreased. However,in blood storage solution group and red cell storage solution group,K^+ level significantly decreased at T2 compared with T1 (P<0.01),then increased gradually but still stayed lower than that in control group at T6;Glu level increased significantly compared with T1 (P<0.01),then decreased with time but still maintained higher than that in control group at T6 (P<0.01).Lac level increased with time in all three groups,but the increased level was different (time×group,P<0.05).At T6,Lac level in blood storage solution group was significantly lower compared with that in control group (P<0.05).Conclusion Red cell storage solution and blood storage solution may not be the best methods for preserving residual blood after CPB in cardiac surgery.