储血器放置不同高度对术中自体回收红细胞溶血损伤的影响

Effects of blood reservoir placed at different height during surgery on the hemolysis injuries of erythrocytes in salvaged blood

目的探讨储血器放置不同高度对脊柱手术患者自体回收红细胞溶血损伤的影响。方法选择拟在全麻下行脊柱手术的择期患者90例,男47例,女43例,年龄33~65岁,体重53~82 kg,ASAⅠ或Ⅱ级,术中均使用自体血液回收机行血液回收。采用随机数字表法随机分为三组:进血口高置组(H组)、进血口正常组(N组)和进血口低置组(L组),每组30例。H组:储血器进血口高于手术野水平30 cm;N组:储血器进血口与手术野同一水平;L组:储血器进血口低于手术野水平30 cm。手术结束前,对储血器内回收的血液进行离心、洗涤,抽取洗涤后的血样,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)、1 h(T1)和2 h(T2)时检测洗涤血样上清液中游离血红蛋白(FHb)的浓度。结果在NaCl浓度为0.48%~0.68%时洗涤血红细胞溶血率H组明显高于N组和L组(P<0.05)。与T0时比较,T1、T2时H组FHb浓度明显升高,T2时N组和L组FHb浓度明显升高(P<0.05);与T1时比较,T2时三组FHb浓度均明显升高(P<0.05)。T1、T2时H组FHb浓度明显高于N组和L组(P<0.05)。结论在血液回收过程中,储血器进血口位于手术野同一水平或低于手术野30 cm时对回收红细胞造成的溶血损伤低于放置在手术野上方30 cm者。

Objective To explore the effects of blood reservoirs placed at different height during spinal surgery on the hemolysis injuries of erythrocytes in salvaged blood. Methods Ninety patients undergoing selective spinal surgery requiring blood salvage, 47 males and 43 females, aged 33-65 years, weighing 53 to 82 kg, ASA physical status Ⅰ or Ⅱ, were randomly divided into three groups(n = 30). The open into blood reservoir of group H was placed 30 cm higher than the operating field, the open into blood reservoir of group N was placed at the same level of the operating field, and the open into blood reservoir of group L was placed 30 cm lower than the operating field. Blood samples were obtained for erythrocyte osmotic fragility test after the salvaged blood was centrifuged and washed, and hemolysis rates in different concentrations of hypotonic NaCl solution were calculated. The concentration of free hemoglobin(FHb) in the clear supernatant liquid of washed blood placed for 0 h(T0), 1 h(T1) and 2 h(T2) were detected. Results Compared with group N and group L, the hemolysis rate of washed erythrocytes in 0.48%-0.68% NaCl solutions of group H was significantly higher(P < 0.05). The concentration of FHb at T1 and T2 in group H and T2 in group N and group L increased compared with that of T0(P < 0.05). Compared with T1, the concentration of FHb at T2 in all the three group increased(P < 0.05). The concentration of FHb in group H was higher than that in group N and group L at T1 and T2(P < 0.05). Conclusion The hemolysis damage of red blood cells during blood collection when the open into blood reservoirs were placed at the same level or 30 cm below the operating field, was lower than that placed at 30 cm above the operating field.