回收式自体血回输对行剖宫产术患者免疫功能及炎症反应的影响

Effects of recovered autologous blood transfusion on immune function and inflammatory response in patients with cesarean section

目的:探讨回收式自体血回输对行剖宫产术患者免疫功能及炎症反应的影响。方法:90例高危出血(中央型前置胎盘、瘢痕子宫等)行剖宫产术患者按自体血回输量分为3组,每组各30例。对照组未进行自体血回输、回输量0~400mL组回输自体血量0~400 mL、回输量400~800mL组回输自体血量400~800 mL。检测各组患者术前(T_(0))、术后即刻(T_(1))、术后24 h(T_(2))、术后48 h(T_(3))血液中HB、RBC、HCT、WBC、CD3^(+)、CD4^(+)、CD8^(+)水平,计算CD4^(+)/CD8^(+)比值,测定血清IL-2、IL-6浓度,记录患者平均动脉压、心率、血氧饱和度及术后发热、住院时间等情况。结果:组内比较,相较T_(0),3组术后各时点CD3^(+)、CD8^(+)、CD4^(+)/CD8^(+)比值、IL-2水平、平均动脉压、心率、血氧饱和度等变化相近(P>0.05),回输量0~400 mL组、回输量400~800 mL组的CD4^(+)在T_(2)时点高于T_(0)(P<0.05),3组IL-6、WBC术后各时点较T_(0)均升高(P<0.05)。对照组HB、RBC、HCT水平在T_(1)时点出现下降,回输量0~400 mL组、回输量400~800 mL组HB、RBC、HCT水平在T_(2)时点出现下降(P<0.05)。组间比较:3组术后同一时间点CD3^(+)、CD8^(+)、CD4^(+)/CD8^(+)比值、IL-2、IL-6、HB、RBC、HCT、WBC、平均动脉压、心率、血氧饱和度、术后发热、住院时间等组间比较变化相近(P>0.05);回输量0~400 mL组、回输量400~800 mL组CD4^(+)浓度在T_(2)时点比对照组升高(P<0.05)。结论:自体血回输不会抑制免疫功能,甚至可短期内改善免疫功能,不会加重机体炎症反应,是安全可用的。

AIM:To investigate the effects of auto-transfusion on immune function and inflammation in patients undergoing cesarean section.METH-ODS:Ninty patients with high risk hemorrhage(central placenta previa,cicatritic uterus,etc.)who underwent cesarean section were divided into three groups according to the amount of autob-lood transfusion,with 30 cases in each group.The control group did not receive autologous blood transfusion,the group with a transfusion volume of 0-400 mL received autologous blood transfusion 0-400 mL,and the group with a transfusion volume of 400-800 mL received autologous blood transfu-sion 400-800 mL.Serum levels of HB,RBC,HCT,WBC,CD3^(+),CD4^(+)and CD8^(+)were detected before surgery(T_(0)),immediately after surgery(T_(1)),24 h after surgery(T_(2)),48 h after surgery(T_(3)),CD4^(+)/CD8^(+)ratio was calculated,and serum levels of IL-2 and IL-6 were measured.The mean arterial pressure,heart rate,oxygen saturation,postoperative fever and length of stay were recorded.RESULTS:Com-pared with T_(0),the changes of CD3^(+),CD8^(+),CD4^(+)/CD8^(+)ratio,IL-2 level,mean arterial pressure,heart rate and oxygen saturation were similar among the three groups at each time point after surgery(P>0.05).CD4^(+)in the 0-400 mL reinfusion group and the 400-800 mL reinfusion group was higher than that in T_(0)at T_(2)(P<0.05),and IL-6 and WBC in the three groups were higher than that in T_(0)at all time points after surgery(P<0.05).The levels of HB,RBC and HCT in the control group decreased at T_(1),while the levels of HB,RBC and HCT in the 0-400 mL and 400-800 mL reinfusion groups decreased at T_(2)(P<0.05).Comparison between groups:at the same time point after surgery,the ratio of CD3^(+),CD8^(+),CD4^(+)/CD8^(+),IL-2,IL-6,HB,RBC,HCT,WBC,mean arterial pressure,heart rate,oxygen saturation,post-operative fever,length of hospital stay and other changes were similar among the three groups(P>0.05).CD4^(+)concentration in 0-400 mL reinfusion group and 400-800 mL reinfusion group was higher at T_(2)than that in control group(P<0.05).CONCLUSION:Autologous blood transfusion can not inhibit immune function,and even improve immune function in the short term.It will not aggravate the inflammatory response of the body,so it is safe and available.