回收式自体输血对体外循环心脏瓣膜置换术患者凝血功能、氧合状况及免疫功能的影响

Effects of autotransfusion on coagulation function,oxygenation status,and immune function in patients undergoing heart valve replacement by extracorporeal circulation

目的 探讨回收式自体输血对体外循环心脏瓣膜置换术患者凝血功能、氧合状况及免疫功能的影响。方法 回顾性分析河南省人民医院心脏中心于2022—2023年期间收治的78例体外循环心脏瓣膜置换术患者的病历资料,根据输血方式不同分为分为对照组38例和研究组40例,对照组患者采取异体输血,研究组患者采取回收式自体输血。比较两组患者的手术时间、体外循环时间、术中失血量、术中输血量,并比较两组患者术前、术后1 d的凝血功能[活化部分凝血活酶时间(APTT)、凝血酶原时间(PT)、D-二聚体(D-D)]、氧合状况[动脉血氧分压(PaO_(2))、混合静脉血氧饱和度(SvO_(2))]及免疫功能[CD3^(+)、CD4^(+)、CD4^(+)/CD8^(+)、自然杀伤(NK)细胞]指标水平。结果 两组患者的手术时间、体外循环时间、术中失血量、术中输血量比较差异均无统计学意义(P>0.05);研究组患者术后1 d的PaO_(2)、SvO_(2)水平分别为(124.89±19.20) mmHg、(86.36±6.20)%,明显高于对照组的(114.98±15.75) mmHg、(83.85±4.24)%,APTT、PT、D-D水平分别为(31.15±5.16) s、(14.64±3.30) s、(0.70±0.24) mg/L,明显低于对照组的(33.63±5.70) s、(16.90±4.64) s、(0.85±0.35) mg/L,差异均有统计学意义(P<0.05);研究组患者术后1 d的CD3^(+)、CD4^(+)、CD4^(+)/CD8^(+)、NK细胞水平分别为(65.14±5.06)%、(46.61±3.83)%、1.85±0.33、(8.34±1.25)%,明显高于对照组的(57.13±5.37)%、(43.32±3.47)%、1.47±0.28、(7.35±1.40)%,差异均有统计学意义(P<0.05)。结论 回收式自体输血可改善体外循环心脏瓣膜置换术的凝血功能、氧合状况,并增强免疫功能,促进术后恢复。

Objective To investigate the effects of autotransfusion(autologous blood transfusion)on coagulation function,oxygenation status,and immune function in patients undergoing heart valve replacement by cardiopulmonary bypass.Methods The medical records of 78 patients undergoing heart valve replacement by cardiopulmonary bypass admitted to Heart Center of Henan Provincial People's Hospital from 2022 to 2023 were retrospectively analyzed.The patients were divided into a control group(n=38)and a study group(n=40)according to different methods of blood transfusion.The control group adopted allogeneic blood transfusion,and the study group adopted autotransfusion.The two groups were compared in operation duration,extracorporeal circulation time,intraoperative blood loss,intraoperative blood transfusion;coagulation function(activated partial thromboplastin time[APTT],prothrombin time(PT),D-dimer[D-D]),oxygenation status(arterial partial pressure of oxygen[PaO_(2)],mixed venous oxygen saturation[SvO_(2)])and the levels of immune function indicators(CD3^(+),CD4^(+),CD4^(+)/CD8^(+),natural killer[NK]cells)before and at 1 d after surgery.Results There was no significant difference in operation duration,cardiopulmonary bypass time,intraoperative blood loss,and intraoperative blood transfusion between the two groups(P>0.05).At 1 d after surgery,the levels of PaO_(2) and SvO_(2) in the study group were(124.89±19.20)mmHg and(86.36±6.20)%,which were significantly higher than(114.98±15.75)mmHg and(83.85±4.24)%in the control group;APTT,PT,and D-D levels were(31.15±5.16)s,(14.64±3.30)s,and(0.70±0.24)mg/L,which were significantly lower than(33.63±5.70)s,(16.90±4.64)s,and(0.85±0.35)mg/L in the control group;the differences were statistically significant(P<0.05).At 1 d after surgery,the CD3^(+),CD4^(+),CD4^(+)/CD8^(+),and NK cell levels of the study group were(65.14±5.06)%,(46.61±3.83)%,1.85±0.33,and(8.34±1.25)%,respectively,which were significantly higher than(57.13±5.37)%,(43.32±3.47)%,1.47±0.28,(7.35±1.40)%of the control group(P<0.05).Conclusion Autotransfusion can improve the coagulation function and oxygenation status of heart valve replacement by cardiopulmonary bypass,enhance immune function and promote postoperative recovery.