洗涤式自体血液回收对糖尿病骨科手术患者红细胞相关指标的影响

Effect of intraoperative blood salvage on related indexes of erythrocyte in orthopedic surgery of diabetic patients

目的观察合并糖尿病的骨科手术患者术中应用洗涤式自体血液回收后红细胞相关指标的变化和对红细胞回收率的影响。方法择期行骨科手术的患者70例，分为7组，每组10例。其中合并糖尿病者根据病史以及糖化血红蛋白（hemoglobin A1c，HbA1c）水平纳入如下6组：病史0—5年，HbA1c〈7％为A1组，HbA1c≥7％为A2组；病史6—10年，HbA1c〈7％为B，组，HbA1c≥7％为B2组；病史大于10年，HbA1c〈7％为C，组，HbA1c≥7％为C2组。无糖尿病者纳入对照组（D组）。比较各组患者出血量、回收血量和红细胞回收率等。在术前（T0）、术中失血回收后洗涤前（T1）及术中失血洗涤后（T1）各取5ml血液标本，检测红细胞相关指标和血气电解质。结果与D组比较，除A1组外其余各组BMI值均明显偏高，且A2组、B2组、C1组和C2组高于A1组，B2组和C2组高于B1组（P〈0．05o与D组比较，B2组和C2组红细胞回收率略低（P〈0．05）。在T0时点，与D组和A1组比较，B2和C2组Hct、Hb和红细胞计数均降低，而同组患者在T0、T1和T2时点三指标均先降低后增高（P〈0．05）。在T0时点，与D组比较，B2组、C1组和C2组红细胞平均体积（erythrocyte mean corpuscular volume，MCV）均增大，C2组大于A1组（P〈0．05）。在T0时点，B2组和C2组平均红细胞血红蛋白含量（mean corpuscular hemoglobin content，MCH）和红细胞平均血红蛋白浓度（mean corpuscular hemoglobin concentration，MCHC）均高于D组和A1组；7组患者MCH均在T1增加，而在R下降至T0水平；同组患者MCHC在T0、T1和T2时点之间差异有统计学意义（P〈0．05）。T0与T1时点，与D组比较，A2组、B2组、C1组和C2组红细胞分布宽度（red blood cell distribution width，RDW）均增宽；与A1组比较，B2组和C2组RDW增宽（P〈0．05）。与R时点比较，各组血液标本pH和Na值在T1和T2均显著上升（P〈0．05）。而各组K^＋在T1均显著上升，在T2下降至低于R水平（P〈0．05）。各组患者T2时血液标本红细胞相关指标和pH、Na^＋以及K^＋差异均无统计学意义（P〉0．05）。结论HbA1c控制不佳的糖尿病骨科手术患者经洗涤式自体血液回收后红细胞相关指标有改变，回收率降低，但可以安全回输。

Objective To explore the effect of intraoperative blood salvage on indexes of erythrocyte in orthopedic surgery of diabetic patients.Methods A total of 70 patients undergoing selective orthopaedics surgery were included in this study.They were divided into 7 groups with 10 patients each.Non-diabetes served as control （Group D）.The others were divided into 6 groups according to the diabetes history and the level of hemoglobin A1c （HbA1c）. 0 to 5-year diabetics whose HbA1c level lower than 7% were incorporated into Group A1,while those whose HbA1c level above 7% belong to group A2,6 to 10-year diabetics were assigned into Group B1 （ HbA1c level less than 7% ） and B2 （more than 7% ）.More than 10 years diabetics were incorporated into Group C1 （ HbA1c level less than 7% ） and C2 （more than 7% ）.The amount of bleeding,blood salvage and erythrocyte recovery rates were compared among the seven groups.5ml blood samples were drawn at three time points,including preoperation（T0）,after blood collection （T1） and washing （T2）,and then blood gas analysis and erythrocyte related index were tested.Results The red blood cell recovery of group B2 （55.2±4.9） % and C2 （52.9±2.7） % dpressed as compared with control（60.1±5.3）% （P〈0.05）. At T0,the erythrocyte mean corpuscular volume of group B2,C1 and C2 rised compared with group D,and goup C2 was higher than group A1（P〈0.05）.The red blood cell distribution width in group A2,B2,C1 and C2 was evidently broadened than group D at T0 and T1.And group B2 and C2 showed increased width compared with group A1（P〈0.05）.The level of pH and Na＋ of each group increased quite significantly at T1 and T2 as compared with T0（P〈0.05）.The K^＋ concentration of each group rised significant at T1 and reduced below the level of T0 at T2（P〈0.05）. There was no difference among all the erythrocyte related index, pH,Na^＋ and K^＋ at T2. Conclusions The recovery rates of erythrocyte in diabetic patients those whose HbA1c were poorly controlled were declined.But the salvaged blood could be retransfused safely.