快速评估自体回收洗涤红细胞质量指标的筛选研究

Screening the parameters to quick evaluate the quality of intraoperative cell salvage

目的筛选适于临床床边快速评估回收血液质量的指标。方法选择行心血管外科手术,术中进行自体血回收的患者25例,使用Fresenius CATS型自体血回收机进行术野血液回收。测定3种清洗模式下洗涤红细胞内的游离血红蛋白(fHb)、白蛋白(ALB)和钙离子(Ca2+)浓度,计算其清除率。比较相同清洗模式下fHb的浓度与清除率与ALB、Ca2+浓度与清除率的相关性与回归关系;选择20例回收洗涤红细胞浓度低于1g/L,比较患者自身静脉血与洗涤红细胞之间2,3-DPG,G-6-PD的变化。结果 3种清洗模式下,ALB的浓度与清除率均是fHb浓度与清除率的显著预测变量,回归关系为YfHb=0.296(ALB)-0.076(P<0.01),YcfHb=0.921(CALB)+0.056(P<0.01);Ca2+的清除率是fHb的清除率的显著预测变量,回归关系为YcfHb=0.620(CCa)+0.355(P<0.01)。当回收洗涤红细胞浓度低于1g/L时,洗涤红细胞的2,3-DPG浓度显著高于自身静脉血(P<0.01)。结论临床上可以将ALB浓度及Ca2+清除率作为评估回收血液清除率的快速检测指标。当fHb<1g/L时,血液回收的洗涤红细胞质量可供临床安全使用。

Objective To screen quick biochemical markers for evaluating the quality of intraoperative cell salvage. Methods Twenty patients undergoing elective cardiovascular surgery were enrolled. Blood was collected and processed using a Fresenius continuous auto-transfusion system device. The concentration of fHb, albumin （Alb）, and calcium （Ca2＋ ） in three washing modes were measured, and their clearance rates were calculated. The correlations among the clearances and concentrations of fHb, albumin, and calcium were analyzed. We also assigned fHb 〈 1 g/L as a rapid assessment quality indicator of cell salvage ,to investigate the contribution of the perioperative cell salvage process to the changes in erythrocyte 2,3- disphosphoglycerate （2,3-DPG） by self-control study compared with venous blood. Results In three washing modes,concentrations and clearance of albumin are significantly associated with fflb ： YfHb = 0.296 （ALB） - 0.076 （ P 〈 0. 01 ）, YcfHb =0.921（CALB） ＋0. 056（P 〈0, 01 ）. Furthermore,the clearance rates of calcium significantly predict clearance of fHb, YefHb = 0.620（CCa） ＋ 0. 355 （P 〈 0. 01 ）. 2,3-DPG activities in washed blood were significantly higher than in venous RBC （ P 〈 0. 01 ）. Conclusion In clinical practice, concentration of albumin, or clearance rates of calcium can be used to evaluate the quality of salvaged blood. When fHb is lower than 1 g/L,the quality of cell salvage was deemed good enough for clinical use.