ECC心脏瓣膜置换患者自体血回输对免疫、携氧及凝血指标的影响

Effects of abstergent autologous blood transfusion on cytoimmunity function and oxygen metabolism, blood coagulation in patients with cardiac valve replacement under extracorporeal circulation

目的探讨心脏体外循环(ECC)心脏瓣膜置换患者自体血回输对免疫、携氧及凝血指标的影响。方法选取2014年1月至2017年6月期间在攀枝花市中西医结合医院行ECC心脏瓣膜置换患者60例,按随机数表法分为对照组与观察组,每组30例,观察组在术中行自体血回输,对照组行异体成分输血,比较两组患者手术时间、术中出血量、输液量,检测并比较两组患者术前、术后24 h时的CD3^+、CD4^+、CD4^+/CD8^+、红细胞计数(RBC)、血小板(PLT)、血红蛋白(HCG)、血红蛋白比容(Hct)、动脉血氧分压(PaO_2)、动脉血氧饱和度(SaO_2)、混合静脉血氧饱和度(SvO_2)、静脉血氧含量(CvO_2)、凝血酶时间(TT)、凝血活酶时间(APTT)、凝血酶原时间(PT)、D-二聚体(D-D)。结果 (1)两组患者的手术时间、术中出血量、输液量比较差异均无统计学意义(P>0.05);(2)CD3^+、CD4^+、CD4^+/CD8^+水平对照组术后24 h时分别为(62.34±9.85)%、(34.14±2.85)%、(1.45±0.20),观察组分别为(68.12±9.78)%、(36.16±2.41)%、(1.59±0.21),两组术后24 h时较术前下降,术后24 h时以上指标对照组低于观察组,差异有统计学意义(P<0.05);(3)RBC、PLT、HCG、Hct、PaO_2、SaO_2、SvO_2、CvO_2水平对照组术后24 h时分别为(3.72±0.52)×10^(12)/L、(117.57±32.44)×10~9/L、(99.89±18.24)g/L、(0.32±0.11)L/L、(13.41±2.10)k Pa、(97.27±0.66)%、(65.12±6.36)%、(135.40±18.95)m L/L,观察组分别为(4.32±0.46)×10^(12)/L、(154.34±51.58)×10~9/L、(117.68±18.45)g/L、(0.38±0.09)L/L、(14.54±1.97)k Pa、(97.23±0.63)%、(75.35±6.30)%、(146.48±15.70)m L/L,RBC、PLT、HCG、Hct、PaO_2、SvO_2、CvO_2两组术后24 h时较术前下降,术后24 h时以上指标对照组低于观察组,差异均有统计学意义(P<0.05),而SaO_2两组手术前后组内及组间比较差异均无统计学意义(P>0.05);(4)对照组D-D术后24 h时为(0.62±0.14)mg/L,高于观察组的(0.51±0.10)mg/L,差异有统计学意义(P<0.05)。结论 ECC心脏瓣膜置换患者自体血回输对免疫功能的抑制较异体输血轻,对携氧及凝血功能影响较小,利于维持血液循环稳定。

Objective To explore the effects of abstergent autologous blood transfusion on cytoimmunity function, oxygen metabolism, blood coagulation in patients with cardiac valve replacement under extracorporeal circu- lation （ECC）. Methods Sixty patients with cardiac valve replacement under extracorporeal circulation in Panzhihua Traditional Chinese and Western Medicine Hospital form January 2014 to June 2017 were randomly divided into con- trol group （30 cases） and observation group （30 cases）. The observation group received autologous blood transfusion, and the control group was given homologous transfusion. The operation time, intraoperative blood loss, and liquid in- put of the two groups, CD3＋ and CD4＋, CD4＋/CD8＋, and red blood cell （RBC）, platelet （PLT）, hemoglobin （HCG）, he- matocrit （Hot）, and PaO2, SaO2, SvO2, CvO2, thrombin time （TT）, activated partial thromboplastin time （APTT）, pro- thrombin time （PT）, D-dimer （D-D） in blood samples were before operation and 24 h after operation were observed and compared between the two groups. Results （1） The operation time, intraoperative blood loss, and liquid input showed no statistically significant differences between the two groups （P〉0.05）. （2） CD3＋, CD4＋, CD4＋/CD8＋ levels at 24 h af- ter operation were （62.34±9.85）%, （34.14±2.85）%, （1.45±0.20） in the control group versus （68.12±9.78）%, （36.16±2.41）%, （1.59±0.21） in the observation group （P〈0.05）. The level at 24 h after operation in the two groups were signifi- cantly lower than those before treatment （P〈0.05）. （3） RBC, PLT, HCG, Hct, PaO2, SaO2, SvO2, CvO2 levels at 24 h af- ter operation were （3.72±0.52）x 101VL, （117.57±32.44）× 10^9/L, （99.89±18.24） g/L, （0.32±0.11） L/L, （13.41±2.10） kPa, （97.27±0.66）%, （65.12±6.36）%, （135.40±18.95） mL/L in the control group, versus （4.32±0.46）×10^12/L, （154.34±51.58） ×10^9/L, （117.68±18.45） g/L, （0.38±0.09） L/L, （14.54±1.97） kPa, （97.23±0.63）%, （75.35±6.30）%, （146.48±15.70） mL/L in the observation group （P〈0.05）. The levels at 24 h after operation in the two groups were significantly lower than those before treatment （P〈0.05）. （4） D-D level at 24 h after operation was （0.624-0.14） mg/L in the control group, ver- sus （0.514-0.10） mg/L in the observation group （P〈0.05）. Conclusion Abstergent autologous blood transfusion has less inhibitory effect on cytoimmunity than homologous transfusion in patients with cardiac valve replacement under extracorporeal circulation, relatively small impact on blood coagulation and oxygen metabolism, which can effectively maintain blood circulation.