去白红细胞预充对婴幼儿心脏手术近期临床预后的影响

Beneficial effects of prestorage leukocyte-reduced red blood cell transfusion on postoperative outcomes in pediatric patients undergoing cardiac surgery

目的 同种异体输血中的白细胞是导致输血后免疫相关性不良反应的主要因素,本临床研究探讨采用储存前去除白细胞的红细胞悬液（简称：去白红细胞）预充对婴幼儿体外循环术预后的影响.方法 队列研究,选取我院2013年11月至2014年5月的体外循环下室间隔缺损修补术患儿,年龄2个月至4岁、且体外循环需要预充红细胞,根据输血科发送的红细胞悬液是否去除白细胞,分为去白红细胞组（n=26）和对照组（n=26）.比较两组患儿氧合指数（OI）、最高乳酸值、白细胞（WBC）计数及中性粒细胞比例（N％）、左室射血分数（LVEF）、术后出血量、呼吸机辅助时间、ICU时间及住院时间.结果 两组基线资料差异无统计学意义（P＞0.05）;去白红细胞组术后6h的OI显著高于对照组（328.18±74.08比280.69±71.11,P＜0.05）、呼吸机辅助时间显著低于对照组[7.0（3,145）比11.5（4,362）,P＜0.05].虽然去白细胞组术后24 h内各时点的胸腔引流量低于对照组（4 h：32.12±39.05比53.92±75.03,8 h：64.04±49.40比92.0±89.82,12 h：104.25±64.11比129.0±94.59,24 h：154.09±59.95比195.68±152.01）,然而差异并无统计学意义（P＞0.05）;其余指标,包括术后乳酸峰值（2.36±0.76比2.51±0.88）、术后1d白细胞计数（13.40±4.86比13.45±5.89）、术后1d中性粒细胞比值（71.8±11.1比74.3±11.93）、术后1 d LVEF（60.2±8.22比58.83±7.76）、ICU时间[81（14,286）比117（19,554）]及住院时间[16（10,34）比18（7,38）]于两组间差异无统计学意义（P＞0.05）.结论 储存前去白红细胞体外循环预充能提高婴幼儿先心病手术后氧合指数、并降低呼吸机辅助时间.

Objective To explore the effectiveness of pre-storage leukocyte-reduced red blood cell transfusion on postoperative outcomes in pediatric cardiac surgery.Methods Between November 2013 and May 2014,according to whether red blood cells from blood bank were leukocyte-depleted or not,52 consecutive pediatric patients undergoing ventricular septal defect repair with red blood cell priming were allocated into leukocyte-depleted （n =26） and control （n =26） groups.The postoperative parameters of maximum lactate,oxygen index （OI）,white blood cell count （WBC）,neutrophil ratio （N％）,left ventricular ejection fraction （LVEF）,chest drainage volume,duration of mechanical ventilation,periods of hospitalization （LOS） and stay in intensive care unit （ICU） were evaluated.Results No significant inter-group differences existed in baseline data （P＞0.05）.Compared to the control group,OI at 6 h postoperation significantly improved （328.18 ± 74.08 vs 280.69± 71.11,P＜0.05）and mechanical ventilation time significantly decreased in the leukocytedepleted group [7.0（3,145） vs 11.5（4,362）,P＜0.05].Although chest drainage volume within 24 h in the leukocyte-depleted group was higher than that in the control group （4 h：32.12± 39.05 vs 53.92±75.03,8h：64.04±49.40 vs 92.0±89.82,12h：104.25±64.11 vs 129.0±94.59,24h：154.09 ± 59.95 vs 195.68 ± 152.01）,there was no significant inter-group differences （P＞0.05）.In the meanwhile,no significant inter-group differences existed in maximum lactate （2.36 ± 0.76 vs 2.51 ±0.88）,WBC（13.40±4.86 vs 13.45 ±5.89）,N％ （71.8± 11.1 vs 74.3± 11.93） or LVEF（60.2 ± 8.22 vs 58.83 ± 7.76）,LOS（81 （14,286） vs 117（19,554）） or ICU stay [16（10,34） vs 18（7,38）] （P＞0.05）.Conclusions In pediatric cardiac surgical patients,pre-storage leukocyte depletion by filtration may result in a significant improvement of OI and a marked reduction of mechanical ventilation.