术中自体或异体输血对内环境和红细胞生成素分泌影响的比较

Comparison of the effects of autotransfusion and homologous transfusion on milieu interieur and secretion of erythropoietin

目的 观察和比较术中自体输血或异体输血对机体内环境和红细胞生成素(erythropoietin,EPO)分泌的影响。方法 30例在全麻下择期行脊柱侧凸矫正术患者,随机分为两组,A组15例,术中按需输注异体血。B组15例,术中对手术失血进行自体血滤过回输,回收率为80％,±2.3％。除常规监测外,术中监测每例患者机体内环境,包括:血常规、血气、电解质、血浆渗透压和ACT。术中、术毕和术后24h测定血浆EPO含量和血常规。结果 A组术中MAP和HCO3-下降较B组明显(P<0.05)。术毕,B组血小板计数(Plt)明显低于A组(P<0.01),但仍在正常范围。两组血浆EPO含量及血常规变化趋势一致。结论 在一定范围内,术中自体血滤过回输有利于维持内环境稳定,对EPO的分泌及红细胞生成的影响与异体输血无明显差异。

Objective To compare the effects of autotransfusion and homologous transfusion on milieu interieurand secretion of erythropoietin (EPO) .Methods Thirty patients aged 8-21 yr undergoing surgical correction of kyphoscoliosis were randomly divided into two groups of fifteen: group A and group B. In group A patients received homologous transfusion during operation, while in group B shed blood was collected from operative field and after filtration RBCs were separated by a differential centrifugation and washed in normal saline and reinfused. Anesthesia was induced with fentanyl 2 μg· kg-1 , propofol 1 mg · kg-1 and vecuronium 0.1 mg · kg-1 and maintained with inhalation of isofiurane and 50% N2O in oxygen and intermittent iv boluses of vecuronium and fentanyl. Blood routine, blood gases, electrolytes, plasma osmotic pressure and activated clotting time (ACT) were measured before operation, 2 h after skin incision and at the end of surgery. Blood EPO concentration was measured before operation, at the end of surgery and 24 h after operation. Results MAP and HCO3- were significantly lower during operation in group A than those in group B. Platelet count was significantly lower at the end of operation in group B than in group A but still within normal range. The EPO level increased at the end of operation and returned to preoperative level 24 h after operation in both groups, and there was no significant difference in EPO levels between the two groups. Conclusion Autotransfusion of the washes RBCs is helpful in maintaining the patients milieu interieur. There is no difference in EPO secretion and erythropoiesis between autotransfusion and homologous transfusion.