储血器内预充MAP溶液对患者自体回收血红细胞损伤的影响

Effect of prefilling blood reservoir with MAP solution on damage to erythrocytes in intraoperative salvaged blood

目的评价储血器内预充甘露醇腺嘌呤磷酸二氢钠（MAP）溶液对患者自体回收血红细胞损伤的影响。方法取150例脊柱手术患者术中自体回收血样150份，采用随机数字表法，分为5组（n=30）：N组、N1组、N2组、M1组和M2组。手术开始前，N组储血器内不预充任何液体，N1组、N2组、M1组和M2组分别在储血器内预充生理盐水100、200ml、MAP溶液100、200ml。自体回收血洗涤后，取血样行红细胞渗透脆性实验，计算在不同浓度的低渗NaCl溶液中红细胞的溶血率。分别于洗涤血样静置即刻（T0）、1h（T1）和2h（T2）时检测洗涤血样上清液中游离血红蛋白（FHb）的浓度。结果与N组和N1组比较，M1组在NaCl浓度为0．48％～0．68％时洗涤血红细胞溶血率降低，T1时FHb浓度降低（P〈0．01），T2时差异无统计学意义（P〉0．05）。与N组和N2组比较，M2组在NaCl浓度为0．48％～0．68％时洗涤血红细胞溶血率降低，T1，2时FHb浓度降低（P〈0．01）。与M1组比较，M2组T2时FHb降低（P〈0．01）。结论储血器内预充MAP溶液可减轻患者自体回收血红细胞损伤，且预充MAP溶液200ml时的效果优于预充100ml。

Objective To evaluate the effect of prefilling blood reservoir with mannitol-adenine- phosphate （MAP） solution on the damage to erythrocytes in intraoperative salvaged blood in patients. Methods One hundred and fifty blood samples were collected from 150 patients who were scheduled for elective spinal surgery requiring blood salvage, and were equally and randomly divided into 5 groups （n = 30 each） using a random number table： group N, group N1, group N2, group M1 and group M2. The blood reservoir was not prefilled before surgery in group N, while the blood reservoirs in N1, N2, M1 and M2 groups were prefilled with normal saline （NS） 100 ml, NS 200 ml, MAP solution 100 ml and MAP solution 200 ml, respectively. Blood samples were obtained for erythrocyte osmotic fragility test after the salvaged blood was washed, and hemolysis rates in different concentrations of hypotonic NaC1 solution were calculated. The concentration of free hemoglobin in the clear supernatant liquid （FHb） of washed blood placed for 0h （T0）, 1 h （Tl） and2h （T2） were detected. Results Compared withN andNlgroups, the hemolysis rate of washed erythrocytes under 0.48%-0.68% NaC1 solutions was significantly decreased, the concentration of FHb at T~ was decreased, and no significant change was found in FHb at T： in group M1. Compared with N and N2 groups, the haemolysis rates of washed erythrocytes under 0.48%-0.68% NaC1 solutions were significantly decreased, and the concentrations of FHb at T1.2 were decreased in group M2. The concentration of FHb was significantly lower at T2 in group M2 than in group MI. Conclusion Prefilling blood reservoir with MAP solution can mitigate the damage to erythrocytes in the intraoperative salvaged blood in patients, and the efficacy of prefilling of 200 ml is superior to that of prefilling of 100 ml.