术中自体血回收-回输术对脊柱手术患者围术期肺功能的影响

Effect of autologous blood withdrawal-reinfusion on pulmonary function in patients undergoing spinal surgery

目的 评价术中自体血回收-回输术对脊柱手术患者肺功能的影响.方法 择期脊柱手术患者40例,年龄28 ～ 64岁,性别不限,体重指数20 ～ 25 kg/m2,ASA分级Ⅰ或Ⅱ级,采用随机数字表法,将其分为2组（n=20）：异体输血组（A组）和自体血回收-回输组（B组）.于输血前即刻（T0）、术中最后1次输血后1 h（T1）、6 h（T2）和24 h（T3）时抽取桡动脉血样,行血气分析,计算氧合指数（OI）及呼吸指数（RI）,采用ELISA法检测肺泡表面活性物质相关蛋白-A（SP-A）浓度,记录输血不良反应及术后72 h内呼吸系统并发症的发生情况.结果 2组各时点OI、RI及血清SP-A浓度比较差异无统计学意义（P＞0.05）,且均在正常范围内;与T0时相比,2组T1,2时OI降低,RI升高,T2,3时血清SP-A浓度降低（P＜0.05）;与T1时相比,2组T3时RI降低,T2,3时血清SP-A浓度降低（P＜0.05）,OI差异无统计学意义（P＞0.05）.2组均未见输血不良反应,A组术后72 h内未见呼吸系统并发症发生,B组有1例发生,组间比较差异无统计学意义（P＞0.05）.结论 术中自体血回收-回输术对脊柱手术患者围术期肺功能无明显影响.

Objective To evaluate the effect of autologous blood withdrawal-reinfusion on pulmonary function in the patients undergoing spinal surgery.Methods Forty patients of both sexes,aged 28-64 yr,with body mass index 20-25 kg/m2,of ASA physical status Ⅰ or Ⅱ,scheduled for elective spinal surgery under general anesthesia,were randomly divided into 2 groups （n =20 each）：allogeneic blood transfusion group （group A） and autologous blood withdrawal-reinfusion group （group B）.Anesthesia was induced with iv midazolam,sufentanil,propofol and rocuronium,and maintained with propofol,remifentanil and cisatracurium.Patients were tracheally intubated and mechanically ventilated.Patients received transfusion of allogeneic blood in group A,while patients received transfusion of intraoperative salvaged blood in group B.Immediately before blood transfusion （T0,baseline）,and at l,6 and 24 h after the last transfusion during operation （T1-3）,blood samples were collected from the radial artery for blood gas analysis and for measurement of serum pulmonary surfactant-associated protein A （SP-A） level.Oxygenation index （OI） and respiratory index （RI） were calculated.Adverse effects of blood transfusion and respiratory complications within 72 h after operation were also recorded.Results No significant differences were found in all the parameters mentioned above at each time point between the two groups,and these parameters were all within the normal range.Compared with the baseline values at T0,OI was significantly decreased and RI was increased at T1,2,and the serum SP-A level was decreased at T2,3 in the two groups.Compared with the value at T1,RI was significantly decreased at T3,the serum SP-A level was decreased at T2-3,and no significant changes were found in OI in the two groups.No adverse effects of blood transfusion were found in the two groups.There were no respiratory complications within 72 h after operation in group A,one case developed respiratory complications within 72 h after operation in group B,and no differences were found between the two groups.Conclusion Autologous blood withdrawal-reinfusion exerts no effect on pulmonary function in the patients undergoing spinal surgery.