自体血回输对心脏瓣膜置换术患者凝血功能及氧化应激反应的影响

Effect of autologous blood transfusion on coagulation function and oxidative stress response in patients undergoing cardiac valve replacement

目的探讨自体血回输对心脏瓣膜置换术患者凝血功能及氧化应激反应的影响。方法将60例择期行心脏瓣膜置换术患者,按照患者及家属输血方式意愿分为预存自体血回输组(研究组)和异体血输血组(对照组),每组30例。比较两组患者术前、停止体外循环、术毕即刻、术后24 h的凝血指标,比较两组术前和停止体外循环后血清α-谷胱甘肽-S-转移酶(α-GST)水平。结果两组患者术前、停止体外循环时、术后24 h凝血指标比较差异均无统计学意义(均P>0.05),而研究组术毕即刻的凝血酶时间、活化部分凝血活酶时间及凝血酶原时间均长于对照组,纤维蛋白原水平低于对照组(均P<0.05)。两组术前血清α-GST水平差异无统计学意义,停止体外循环时研究组血清α-GST水平高于对照组(P<0.05)。结论在心脏瓣膜置换术中应用自体血回收技术输血安全、有效,对提高患者抗氧化能力具有积极作用,有助于减轻患者心肌再灌注损伤。

Objective To investigate the effect of autologous blood transfusion on coagulation function and oxidative stress response in patients undergoing cardiac valve replacement.Methods Sixty patients undergoing selective cardiac valve replacement were divided into preserved autologous blood transfusion group(study group)and allogeneic blood transfusion(control group)according to the intention of transfusion approach of patients and their family members,with 30 cases in each group.The coagulation indices before operation,at the time of cardiopulmonary bypass withdrawal,immediately after operation,and 24 hours after operation were compared between the two groups,and serum levels ofα-glutathione-S-transferase(α-GST)before operation and after cardiopulmonary bypass withdrawal were compared between the two groups.Results There was no statistically significant difference in coagulation indices between the two groups before operation,at the time of cardiopulmonary bypass withdrawal,or 24 hours after operation(all P>0.05),furthermore,the study group had longer thrombin time,activated partial thromboplastin time and prothrombin time immediately after operation,and lower fibrinogen level as compared with the control group(all P<0.05).There was no statistically significant difference in serumα-GST level between the two groups before operation,and after cardiopulmonary bypass withdrawal,serumα-GST level in the study group was higher than that in the control group(P<0.05).Conclusion The application of autologous blood transfusion technology to cardiac valve replacement is safe and effective,which plays a positive role in improving antioxidant capacity and contributes to reducing myocardial reperfusion injury in the patients.