贮存式自体输血用于脊柱外科手术的效果分析

Analysis of the effect of stored autologous blood transfusion in spinal surgery

目的:探讨贮存式自体输血(PABD)在脊柱外科手术中的安全性和有效性。方法:选取2022年1月—2022年12月在天津市天津医院进行脊柱外科择期手术患者进行回顾性研究,采用PABD的患者作为自体输血组,异体输血患者作为对照组,每组各54例,比较两组患者术中出血量、术后引流量、总出血量、术中输血量和住院时间以及两组患者术前及术后48 h各项血常规指标、凝血结果和免疫水平等。结果:与对照组相比,自体输血组术中输血量显著降低(t=43.28,P<0.05),住院时间缩短(t=7.06,P<0.05);与术前相比,对照组术后48 h血红蛋白(Hb)、红细胞压积(HCT)、红细胞(RBC)、血小板(PLT)水平明显降低;与对照组比,自体输血组术后48 h Hb、HCT、RBC、PLT水平均有显著性差异(t=10.28、6.63、6.20、5.60,均P<0.05);两组患者术后48 h白细胞(WBC)水平均显著升高,但自体输血组低于对照组(t=18.80,P<0.05);两组患者术前术后凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、D二聚体(D-D)、纤维蛋白原(Fib)比较差异均无统计学意义(均P>0.05);与对照组比,自体输血组术后48 h体液免疫指标免疫球蛋白A(IgA)、免疫球蛋白G(IgG)和免疫球蛋白M(IgM)以及细胞免疫指标CD4^(+)T细胞、CD4^(+)T细胞与CD8(+)T细胞比值、自然杀伤细胞(NK细胞)水平均显著性升高(t=14.42、52.27、3.39、6.76、8.62、1.99,均P<0.05),CD8^(+)T细胞水平显著下降(t=4.70,P<0.05);自体输血组手术前后各项免疫指标差异并不明显(均P>0.05)。结论:PABD应用于脊柱外科手术是安全且有效的。

Objective:To explore the safety and effectiveness of stored autologous blood transfusion(PABD)in spinal surgery.Methods:A retrospective study was conducted on patients undergoing elective spinal surgery at Tianjin Hospital from January 2022 to December 2022.Patients who received PABD or allogeneic blood transfusion were divided into allogeneic blood transfusion group and control group,with 54 cases in each group.The intraoperative bleeding volume,postoperative drainage volume,total bleeding volume,allogeneic transfusion volume,and length of hospital stay,as well as various blood routine indicators,coagulation results,and immune levels before and 48 hours after surgery were compared between the two groups of patients.Results:Compared with the control group,the amount of allogeneic blood transfusion was significantly reduced(t=43.28,P<0.05),hospitalization time was shortened(t=7.06,P<0.05)in the autologous blood transfusion group.Compared with before surgery,the hemoglobin(Hb),hematocrit(HCT),red blood cell(RBC),and platelet(PLT)levels were significantly reduced 48 hours after surgery in the control group.At 48 hours after surgery compared with control group,there were significant differences in Hb,HCT,RBC,PLT levels in the autologous blood transfusion group(t=10.28,6.63,6.20,5.60,all P<0.05).The white blood cell(WBC)levels of both groups of patients significantly increased 48 hours after surgery,but the autologous blood transfusion group was lower than that in the control group(t=18.80,P<0.05).There was no statistically significant difference in prothrombin time(PT),activated partial thromboplastin time(APTT),D-Dimer(D-D),and fibrinogen(Fib)between the two groups of patients before and after surgery(all P>0.05).Compared with the control group,the levels of humoral immune markers immunoglobulin A(IgA),immunoglobulin G(IgG),and immunoglobulin M(IgM),as well as cellular immune markers CD4^(+)T cell and CD4^(+)T cell/CD8^(+)T cell and natural killer cell(NK cell)in the control group were significantly increased in the autologous blood transfusion group 48 hours after surgery(t=14.42,52.27,3.39,6.76,8.62,1.99,all P<0.05),while the CD8^(+)T cell levels were significantly decreased(t=4.70,P<0.05).There was no significant difference in various immune indicators before and after surgery in the autologous blood transfusion group(all P>0.05).Conclusion:The application of PABD in spinal surgery is safe and effective.