加压输血对红细胞及血液质量影响的研究

Experimental study on RBC and blood quality during pressurized transfusion

目的:研究在不同压力下快速输注去白全血对细胞形态、溶血率及游离血红蛋白的影响,筛选安全快速输注血液的施压强度,为野战条件下加压输血提供理论依据。方法:取400 ml去白全血,分别连接不同型号静脉留置针(18 G、20 G、22 G、24 G)进行平行试验,观察未加压及施加5 kPa、10 kPa、15 kPa、20 kPa情况下血液流速、红细胞形态和游离血红蛋白浓度的变化,评价不同压力对血液流速和红细胞溶血情况的影响,同时与现有的输血加压袋进行对比试验。结果:血液在不同施压下红细胞溶血率及血浆游离血红蛋白含量变化差异无统计学意义(P>0.05),随着压力的增加,高倍显微镜视野中出现少量变型红细胞和细胞碎片。在5 kPa的压力下采用22 G针头可提高输血速度至少3倍,压力在5~20 kPa血液游离血红蛋白测定值为0.073~0.152 g/L。结论:在20 kPa以内的施压范围内加压输血,短时间血液中游离血红蛋白及溶血率无明显变化,更高的压力可出现红细胞形态稍有改变,但血液质量完全符合临床输血的质量标准和我军《战时输血游离血红蛋白限值》的相关要求,加压输血适合在野战医疗所以及伤员在转运过程中使用。

Objective:To observe the change of RBC morphologic,hemolysis rate and hemoglobin during the different transfusion compression in order to provide some theoretical basis for wartime blood transfusion. Method:The 400 ml whole blood of leukocyte reduced were selected,then connected apparatus transfusion with different numbers types of intravenous detaining needles(18 G,20 G,22 G and 24 G).The different pressures(0 kPa,5 kPa,10 kPa,15 kPa and 20 kPa)had exerted on blood bag.The ratio of haemolysis,the changes of RBCs morphologic and blood hemoglobin as blood flow outpinhead end had been observed.At the same time the contrast experiment with the existing pressure bags were carried on. Result:The differences of ratio of haemolysis and blood hemoglobin had no statistic significance(P>0.05)under different pressure.The results showed under high electron microscope few anamorphic RBC and some cells debris.Under the pressure of 5 kPa using 22 G needles raised transfuse blood speed at least 300%.The blood dissociated hemoglobin changed between 0.073-0.152 g/L within the pressure from 5 to 20 kPa as blood flow through apparatus transfusion.Conclusion:The ratio of haemolytic and blood dissociated hemoglobin had no significant changes within the pressure of 20 kPa in short time.Only few RBCs morphologic change had been found followed with higher pressure.The blood quality completely conformed the request according to the quality standard of clinical blood transfusion and《Standard requirement of blood transfusion hemoglobin at wartime》.It was very suitable for the vilifies in the camp rescue and during the period of transporting.