摘要
目的比较异体输血和稀释式自体输血对剖宫产术患者细胞免疫功能的影响。方法择期剖宫产术患者60例，年龄20-35岁，体重50～80kg，ASA分级Ⅰ或Ⅱ级，采用随机数字表法，分为2组（n=30）：稀释式自体输血组（HAT组）和异体输血组（ABT组）。2组均采用硬膜外麻醉，HAT组在硬膜外麻醉操作成功后行桡动脉置管并采集自体血。自体输血时机：出血量超过全身血容量的20％；对出血量少于全身血容量20％者，则在出血基本止住，关腹后静脉输注自体血；异体输血时机：Hb〈70g／L静脉输注浓缩红细胞1～5U，PT或APTT〉正常值1．5倍时静脉输注新鲜冰冻血浆100～400ml；Plt〈50×10^9／L时静脉输注血小板10～40u。于入室（T0）、术后第1天（T1）、术后第5天（T2）时采集血样，采用FACScan流式细胞仪检测全血T淋巴细胞亚群CD3^＋、CD4^＋和CD8^＋水平，计算CD4^＋／CD8^＋比值，采用ELISA法测定血清IL-2和IL-6的浓度。结果与T0时比较，ABT组T1,2时、HAT组T1时全血CD3^＋、CD4^＋水平和CD4^＋／CD8^＋比值降低，血清IL-2浓度降低，血清IL-6浓度升高（P〈0．05）；与ABT组比较，HAT组T1时全血CD3^＋、CD4^＋水平、CD4^＋／CD8^＋比值和血清IL-6浓度升高，T1，2时血清IL-2浓度升高（P〈0．05）。结论稀释式自体输血对剖宫产术患者细胞免疫功能的抑制程度较异体输血减轻。
Objective To compare the effects of allogeneic blood transfusion and hemodiluted autotransfusion on cellular immune function in the patients undergoing cesarean section. Methods Sixty patients, aged 20-35 yr, weighing 50-80 kg, of American Society of Anesthesiologists physical status I or II , scheduled for elective cesarean section, were randomly divided into 2 groups （n = 30 each） using a random number table： hemodiluted autotransfusion group （group HAT） and allogeneic blood transfusion group （group ABT）. Both groups received epidural anesthesia. The radial artery was cannulated after epidural anesthesia, and the autologous blood was collected in group HAT. The autologous blood transfusion timing： intraoperative blood loss was expected to exceed 20% of blood volume. For the patients in whom intraoperative blood loss was not expected to exceed 20% of blood volume, bleeding was stopped, and autologous blood was infused intravenously after peritoneum closure. The allogeneic blood transfusion timing： when hemoglobin 〈 70 g/L, packed red blood cells 1- 5 U were infused intravenously; when prothrombin time, or activated partial thromboplastin time 〉 1.5 times of the normal value, the fresh frozen plasma 100-400 ml was infused intravenously; when platelet count〈50× 10^9/L, platelets 10-40 U were infused intravenously. When entering the operating room （T0） , on 1st day after operation （T1） , and on 5th day after operation （T2） , blood samples were collected to detect the levels of T lymphocyte subsets CD3＋, CD4＋ and CD8＋ （using FACScan flow cytometer）, and serum interleukin-2 （IL-2） and IL-6 concentrations （by enzyme-linked immunosorbent assay）. CD4＋/CD8＋ ratio was calculated. Results Compared with the values at To, the levels of CD3＋ and CD4＋, CD4＋/CD8＋ ratio, and serum IL-2 concentrations were significantly decreased, and the serum IL-6 concentrations were increased at T1,2 in group ABT, and at T1 in group HAT （P〈0.05）. Compared with group ABT, the CD3＋ and CD4＋ levels, CD4＋/CD8＋ ratio and serum IL-6 concentrations were significantly increased at T1 , and the serum IL-2 concentrations were increased at T1,2 in group HAT （P〈0.05）. Conclusion Compared with allogeneic transfusion, hemodiluted autotransfusion has less inhibitory effect on cellular immune function in the patients undergoing cesarean section.
出处
《中华麻醉学杂志》
CAS
CSCD
北大核心
2016年第2期199-202,共4页
Chinese Journal of Anesthesiology
基金
湖州市科技计划项目（2012YSB28）
关键词
输血
自体
血液成分输血
剖宫产术
免疫
细胞
Blood transfusion, autologous
Blood component transfusion
Cesarean section
Immunity, cellular
