急性等容性血液稀释联合术中回收式自体输血对老年心脏手术患者输血量及凝血功能的影响

Effects of acute normovolemic hemodilution combined with intraoperative recycled autotransfusion on blood transfusion volume and coagulation function in elderly patients undergoing cardiac surgery

目的 探讨急性等容性血液稀释联合回收式自体输血用于老年心脏手术患者时,对其输血量及凝血功能的影响。方法 选取本院2020年3月~2022年3月94例老年心脏手术患者,随机分为观察组(n=47)与对照组(n=47),观察组给予急性等容性血液稀释联合术中回收式自体输血,对照组给予常规异体输血,比较2组输血量、氧合状况、免疫功能、炎性指标水平以及不良反应发生情况。结果 观察组库血输注量为(1.73±0.43)U少于对照组(5.71±1.71)U(P<0.05);观察组术后6 h时血氧饱和度(SvO2)水平为(74.59±7.20)%高于对照组(67.22±6.19)%,氧摄取率(ERO2)水平为(0.29±0.06)%低于对照组(0.34±0.05)%(P<0.05);观察组术后1d时CD3^(+)、CD4^(+)、CD4^(+)/CD8^(+)、自然杀伤细胞(NK)水平分别为(65.11±5.14)%、(46.93±5.17)%、1.86±0.30、(8.35±1.23)%高于对照组(57.45±7.24)%、(43.58±4.85)%、1.47±0.36、(7.34±1.38)%,CD8^(+)细胞水平为(25.17±4.01)%低于对照组(30.39±5.06)%(P<0.05);观察组术后1 d时血清白介素6/8(IL-6/-8)、肿瘤坏死因子-α(TNF-α)水平分别为(104.51±12.55)ng/L、(351.42±52.86)ng/L、(254.93±49.94)ng/L低于对照组(125.81±14.96)ng/L、(394.27±55.78)ng/L、(323.60±52.63)ng/L(P<0.05);观察组不良反应发生率4.26%低于对照组17.02%(P<0.05)。结论 老年心脏手术中,回收式自体输血可减少异体输血量,对血常规和凝血功能的影响与异体输血无差异,且相较于异体输血可明显改善氧合,减轻免疫抑制和炎症反应,降低不良反应发生风险。

Objective To explore the effects of acute normovolemic hemodilution(ANH)combined with intraoperative recycled autotransfusion on blood transfusion volume and coagulation function in elderly patients undergoing cardiac surgery.Methods A total of 94 elderly patients undergoing cardiac surgery in the hospital were enrolled and randomly divided into observation group(n=47)and control group(n=47)between March 2020 and March 2022.The observation group was given ANH combined with intraoperative recycled autotransfusion,while control group was given routine allogeneic transfusion.The blood transfusion volume,oxygenation status,immune function,inflammatory indexes and adverse reactions in the two groups were compared.Results The banked blood transfusion volume was less in observation group than control group[(1.73±0.43)U us(5.71±1.71)U,P<0.05].At 6 h after surgery,blood oxygen saturation(Sv0,)level was higher[(74.59±7.20)%vs(67.22±6.19)%],while 0xygen uptake rate(ER0,)level was lower[(0.29±0.06)%vs(0.34±0.05)%]in observation group than control group(P<0.05).At day 1 after surgery,levels of CD3^(+),CD4^(+),CD4^(+)/CD8^(+)and natural killer cells(NK)were higher[(65.11±5.14)%,(46.93±5.17)%,(1.86±0.30),(8.35±1.23)%vs(57.45±7.24)%,(43.58±4.85)%,(1.47±0.36)%,(7.34±1.38)%],while CD8^(+)was lower[(25.17±4.01)%vs(30.39±5.06)%] in observation group than control group(P<0.05).At day 1 after surgery,levels of serum interleukin 6/8(IL-6/8)and tumor necrosis factor-α(TNF-α)were lower in observation group than control group[(104.51±12.55)ng/L us(125.81±14.96)ng/L,(351.42±52.86)ng/Lus(394.27±55.78)ng/L,(254.93±49.94)ng/Lus(323.60±52.63)ng/L,P<0.05].The incidence of adverse reactions was lower in observation group than control group(4.26%vs 17.02%),P<0.05.Conclusion Recycled autotransfusion can reduce allogeneic transfusion volume in elderly patients undergoing cardiac surgery.There is no difference in the effects on blood routine or coagulation function between recycled autotransfusion and allogeneic transfusion.Compared with allogeneic transfusion,recycled autotransfusion can significantly improve oxygenation status,relieve immunosuppression and inflammation response,and reduce the risk of adverse reactions.