术中自体血回输与输注异体血对脊柱手术术后血液流变学的影响

Influence of autologous blood transfusion versus allogeneic blood transfusion on hemorheology after spinal surgery

目的对比术中自体血回输和输注异体血对脊柱手术病人血液流变学(凝血功能)的影响,进一步探讨术中血液回收的安全性和可行性。方法选择2015年1月至2016年12月我院收治的术前实验室检验正常、无凝血功能异常且未接受抗凝治疗、非恶性肿瘤、术中血液无污染的骨科脊柱开放性手术病人100例。严格遵守献血与输血的伦理准则分组:(1)自体血液回输组(自体组),即术中回输经洗涤处理的自体血,男22例,女28例;(2)异体输血组(异体组),即行异体输血,男23例,女27例。两组病人一般资料比较,差异均无统计学意义(均P>0.05)。同时进行血液流变学项目监测,并对比输血对病人凝血功能的影响。结果自体组的术中回输自体血量为(289.4±55.7)ml,少于异体组的异体输血量[(396.5±141.1)ml],两者比较差异有统计学意义(t=4.992,P<0.05)。术后第3天两组病人的红细胞压积,自体组为31.00%±5.84%,小于异体组的34.25%±6.15%,两组比较差异具有统计学意义(t=2.710,P=0.007);两组病人其余血液流变学参数比较,差异均无统计学意义(均P>0.05)。术后第7、14天,两组病人各项血液流变学参数比较,差异均无统计学意义(均P>0.05)。结论自体血回输对血液流变学参数的影响与输注异体血相比无显著差异,可广泛应用于临床。

Objective To compare the effects of autologous blood transfusion versus allogeneic blood transfusion for spinal surgery patients(blood coagulation)and to further explore the safety and feasibility of intraoperative blood recycling during operation.Methods From January 2015 to December 2016,a total of 100 orthopaedic open spinal surgery patients with no blood coagulation disorders,no anticoagulant therapy,no malignant tumor and no blood contamination were selected and divided into two groups,strictly based on the ethical criteria of blood donation and blood transfusion:autologous blood transfusion group,undergoing autotransfusion of blood after washing in operation,includes 22 males and 28 females with an average age of(48.9±12.8)years and with a mean weight of(59.3±9.8)kg;allogeneic blood transfusion group,including 23 males and 27 females with the average age of(51.5±11.2)years and the average weight of(58.0±10.9)kg.There was no significant difference between the two groups(all P>0.05).All patients were monitored by the blood rheology project simultaneously and the effects of the two different kinds of blood transfusion on blood coagulation function were compared.Results There was significant difference(t=4.992,P<0.05)between the autologous blood transfusion group and allogeneic blood transfusion group[intraoperative volume of autologous blood(289.4±55.7)ml vs.allogeneic blood volume of(396.5±141.1)ml].On the third day after the operation,the HCT in the autologous blood collection group was 31.00%±5.84%,significantly lower than that in the allogeneic blood transfusion group(34.25%±6.15%)(t=2.710,P=0.007).There was no significant difference in the rest hemorheological parameters between the two groups(P>0.05).What--smore,there was no significant difference in the hemorheological parameters on the seventh or fourteenth day after operation(P>0.05).Conclusion The effect of autologous blood transfusion on hemorheological parameters was not significantly different from that of allogeneic blood transfusion,so autologous blood transfusion can be widely applied to clinical practice.