择期心脏手术患者术中回收自体血液红细胞2,3-二磷酸甘油酸和游离血红蛋白水平的变化研究

Effects of intraoperative cell salvage on erythrocyte 2,3-disphosphoglycerate and free hemoglobin level in patients undergoing elective cardiac surgery

目的探讨心脏择期手术中自体血液回收对回收红细胞2,3-二磷酸甘油酸(2,3-DPG)和游离血红蛋白(FHb)浓度的影响。方法选择15名择期心脏手术的患者,使用自体血液回收机在术中收集并洗涤回收的血液。测定和比较回收洗涤红细胞、患者自体静脉血红细胞和贮存2周的库存红细胞的2,3-DPG水平、f Hb的浓度及溶血率;进一步测定和比较回收洗涤红细胞贮存在4 h(21-24℃)和24 h(1-6°C)上述指标的变化。2,3-DPG水平测定采用化学比色法,FHb浓度使用分光光度仪检测。结果 15名患者术中均没有输注异体红细胞。患者静脉血、回收洗涤红细胞在0 h、4 h、24 h和库血保存2周的2,3-DPG值(μmol/g Hb)分别为12.73±6.52、17.94±6.91、15.17±11.61、15.38±5.85和2.62±3.13,其中回收洗涤红细胞0 h 2,3-DPG含量明显高于静脉血(P<0.01)和库血(P<0.01),和4 h、24 h的2,3-DPG值相比均无明显变化(P<0.05)。患者静脉血、回收洗涤红细胞在0 h、4 h、24 h和库血保存2周溶血率(%)分别为0.07±0.05、0.51±0.27、1.11±0.42、1.75±0.69和0.07±0.05,其中回收洗涤红细胞0 h溶血率明显高于静脉血(P<0.01)和库血(P<0.01),明显低于回收洗涤红细胞4 h溶血率(P<0.01)和24 h溶血率(P<0.01)。结论在心脏手术中回收的患者自体血液中的红细胞被轻度破坏,但供氧能力较好。

Objective To assess the effect of intraoperative cell salvage on 2,3-disphosphoglycerate（ 2,3-DPG） and free hemoglobin（ f Hb） level of red blood cells（ RBCs） during elective cardiac surgery. Methods Fifteen patients scheduled for elective cardiac surgery were enrolled in this study. One auto-transfusion device was used to process the collected blood salvaged during the operation. The level of f Hb and 2,3-DPG from venous RBCs,salvaged RBCs and 2-week-old stored RBCs were measured. The changes of the above indexes of RBCs stored at 21-24 ℃ for 4 h and at 1-6 ℃ for 24 h were further measured. Results The 2,3-DPG level（ μmol / g Hb） of venous RBCs,salvaged RBCs at 0 h,4 h and 24 h,as well as2-week-old stored RBCs was 12. 73±6. 52,17. 94±6. 91,15. 17±11. 61,15. 38± 5. 85 and 2. 62± 3. 1,respectively. The 2,3-DPG level of 0 h salvaged RBCs was significantly higher than that of venous RBCs（ P〈 0. 01）,and that of 2-week-old stored RBCs（ P〈 0. 01）,while there was no statistically significant difference compared with the 2,3-DPG level of 4 h salvaged RBCs（ P〈 0. 05） and the 2,3-DPG level of 24 h salvaged RBCs（ P〈 0. 05）. The percentage of hemolysis（ %） of venous RBCs,salvaged RBCs at 0 h,4 h and 24 h,and 2-week-old stored RBCs was 0. 07±0. 05,0. 51±0. 27,1. 11±0. 42,1. 75±0. 69 and 0. 07±0. 05,respectively. The percentage of hemolysis of 0h salvaged RBCs was significantly higher than that of venous RBCs（ P〈 0. 01）,and that of 2-week-old stored RBCs（ P〈 0. 01）,and also it was significantly lower than that of4 h salvaged RBCs（ P〈 0. 01） and that of 24 h salvaged RBCs（ P〈 0. 01）. Conclusion The salvaged RBCs during elective cardiac surgery was slightly destroyed,but had a better oxygen-carrying capacity.