贮存式自体输血和异体输血对老年脑外科手术患者炎症反应及T淋巴细胞亚群的影响

Effects of Storage Autotransfusion and Allogeneic Transfusion on Inflammatory Response and T Lymphocyte Subsets in Elderly Patients Undergoing Brain Surgery

目的:探讨老年脑外科手术患者分别经贮存式自体输血和异体输血后,其对机体T淋巴细胞亚群和炎症反应的影响。方法:选取2017年3月~2019年10月期间我院收治的行脑外科手术老年患者150例,根据随机数字表法将患者分为对照组(n=75,异体输血)和研究组(n=75,贮存式自体输血),对比两组围术期相关指标情况,比较两组术前、术后5d的炎症因子水平[白介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)、C反应蛋白(CRP)]以及T淋巴细胞亚群变化情况,记录两组输血不良反应发生情况。结果:两组术前住院时间、术前血红蛋白比较差异无统计学意义(P>0.05);研究组术后住院时间短于对照组,术中出血量、术中输血量少于对照组,术后血红蛋白多于对照组(P<0.05)。两组术后5d IL-6、CRP、TNF-α均升高,但研究组低于对照组(P<0.05)。两组患者术后5d CD3+、CD4+/CD8+、CD4+均降低,但研究组高于对照组,CD8+升高,但研究组低于对照组(P<0.05)。研究组输血不良反应发生率低于对照组(P<0.05)。结论:与异体输血应用于老年脑外科手术患者相比,贮存式自体输血效果确切,可减轻炎性应激,降低免疫抑制,同时还可减少输血不良反应发生率,节约宝贵的血液资源。

Objective: To investigate the effects of storage autotransfusion and allogeneic blood transfusion on inflammatory response and T lymphocyte subsets in elderly patients undergoing Department of cerebral surgery. Methods: 150 elderly patients undergoing brain surgery in our hospital from March 2017 to October 2019 were selected, they were divided into control group(n = 75,allogeneic blood transfusion) and study group(n = 75, storage autotransfusion) according to the method of random number table. The perioperative indexes of the two groups were compared, the changes of inflammatory factors [Interleukin-6(IL-6), tumor necrosis factor-α(TNF-α), C-reactive protein(CRP)] and T-lymphocyte subsets were compared between the two groups before and 5 d after operation, the adverse reactions of blood transfusion were recorded in two groups. Results: There was no significant difference in preoperative hospitalization time and hemoglobin between the two groups(P > 0.05). The postoperative hospitalization time of the study group was shorter than that of the control group, the amount of intraoperative blood loss and intraoperative blood transfusion was less than that of the control group, and the postoperative hemoglobin was more than that of the control group(P < 0.05). The levels of IL-6, CRP and TNF-α in the study group were higher than those in the control group(P < 0.05). CD3^+, CD4^+/CD8^+, CD4^+were decreased in the two groups 5 d after operation, but the study group were higher than those of the control group, CD8^+were increased, but the study group were lower than that of the control group(P < 0.05). The incidence of adverse reactions in the study group was lower than that in the control group(P < 0.05). Conclusion: Compared with the allogeneic transfusion, the storage autotransfusion can reduce the immunosuppression and inflammatory stress, reduce the incidence of adverse reactions, and save valuable blood resources.