【摘要】：背景：圍術(shù)期血液丟失是外科手術(shù)的一個(gè)主要問題。圍術(shù)期失血可以導(dǎo)致術(shù)后血紅蛋白降低,其傳統(tǒng)的治療方法是同種異體輸血。盡管做了很多努力來改進(jìn)異體血的質(zhì)量,但是異體輸血的風(fēng)險(xiǎn)依然很大。除了眾所周知的傳染病的傳播、輸血相關(guān)發(fā)熱反應(yīng)、輸血相關(guān)急性肺損傷等風(fēng)險(xiǎn)外,人們還關(guān)注異體輸血與免疫調(diào)節(jié)的因果關(guān)系。輸血可以導(dǎo)致機(jī)體免疫系統(tǒng)受到抑制,從而增加術(shù)后感染、傷口延遲愈合的發(fā)生率,并最終使住院時(shí)間延長(zhǎng)。 異體輸血的替代方法包括術(shù)前自體貯血、術(shù)中急性等容血液稀釋、術(shù)中自體血液和術(shù)后引流血液的回收和回輸?shù)取Ｆ渲?術(shù)中自體血回收是一種重要的血液保護(hù)措施,可以有效減少異體血需求和相關(guān)并發(fā)癥。但目前常規(guī)的洗滌、過濾方法不能徹底去除自體血中的白細(xì)胞,從而導(dǎo)致活化的白細(xì)胞、細(xì)胞因子和其它的小顆粒凝聚物混雜其中。上述自體血回輸后可以加重患者術(shù)后全身炎癥反應(yīng)程度,可以在一定程度上影響患者的臨床結(jié)局。在自體血回輸前加用自體血液過濾器可能是減輕以上不良反應(yīng)的一種有效方法。 目的：觀察術(shù)中自體血回輸對(duì)患者全身炎癥反應(yīng)的影響,比較使用自體血液過濾器是否可以減輕回輸自體血導(dǎo)致的全身炎癥反應(yīng)。 材料與方法：選取全麻下行脊柱側(cè)彎后路矯形內(nèi)固定手術(shù)患者30例,根據(jù)計(jì)算機(jī)隨機(jī)數(shù)字表隨機(jī)分為對(duì)照組(Cell Saver5+處理后的自體血直接回輸)和實(shí)驗(yàn)組(Cell Saver5+處理后的自體血經(jīng)Pall LipiGuard SB1型血液過濾器過濾后回輸)各15例。分別取術(shù)前體內(nèi)血、回收自體血、洗滌自體血、過濾自體血(限實(shí)驗(yàn)組)、回輸前體內(nèi)血、回輸后2h體內(nèi)血、回輸后24h體內(nèi)血及回輸后72h體內(nèi)血各5ml,分別檢測(cè)血常規(guī)、IL-6、IL-10和NE的水平。記錄患者術(shù)后恢復(fù)和并發(fā)癥發(fā)生情況。 統(tǒng)計(jì)學(xué)處理：所有數(shù)據(jù)用均數(shù)±標(biāo)準(zhǔn)差或中位數(shù)(25%分位數(shù),75%分位數(shù))進(jìn)行描述,使用SAS9.2統(tǒng)計(jì)軟件利用廣義線性混合模型(Genaralized linear mixed model)對(duì)組內(nèi)和組間的差異進(jìn)行檢驗(yàn)。 結(jié)果：兩組回收血白細(xì)胞計(jì)數(shù)均高于術(shù)前(P0.001),洗滌和過濾后下降(P0.001)。實(shí)驗(yàn)組過濾血中性粒細(xì)胞百分比低于洗滌血(P=0.013)。實(shí)驗(yàn)組IL-6水平低于對(duì)照組(p=0.001)。實(shí)驗(yàn)組未發(fā)現(xiàn)術(shù)后并發(fā)癥,對(duì)照組出現(xiàn)術(shù)后傷口液化和肺部感染各1例。 結(jié)論：自體血液過濾器用于術(shù)中自體血回輸可以有效降低自體血中的白細(xì)胞數(shù)量、中性粒細(xì)胞百分比和IL-6的水平,從而減輕患者術(shù)后全身炎癥反應(yīng)程度。
[Abstract]:Background: perioperative blood loss is a major problem in surgery. Perioperative blood loss can lead to postoperative hemoglobin reduction, the traditional treatment is allogeneic blood transfusion. Despite efforts to improve the quality of allogeneic blood, the risk of allogeneic blood transfusion remains high. In addition to the well-known risk of transmission of infectious diseases, transfusion-related fever, transfusion-related acute lung injury, there is also concern about the causal relationship between allogeneic transfusion and immunomodulation. Blood transfusion can inhibit the immune system, increase the incidence of postoperative infection and delayed wound healing, and ultimately prolong the hospital stay. Alternative methods of allogeneic blood transfusion include preoperative autologous blood storage, intraoperative acute isovolemic hemodilution, intraoperative autogenous blood and postoperative drainage blood recovery and re-transfusion. Among them, autologous blood recovery during operation is an important blood protection measure, which can effectively reduce the demand for allogeneic blood and related complications. However, the conventional washing and filtration methods can not completely remove white blood cells from autogenous blood, which leads to the mixture of activated leukocytes, cytokines and other small particle aggregates. The above autotransfusion can aggravate the postoperative systemic inflammatory reaction and affect the clinical outcome of the patients to a certain extent. The use of autogenous blood filter before autotransfusion may be an effective way to reduce the adverse reactions mentioned above. Aim: to observe the effect of intraoperative autotransfusion of autologous blood on systemic inflammatory response and to compare the effect of autologous blood filter on systemic inflammatory response induced by transfusion of autologous blood. Materials and methods: 30 patients undergoing posterior correction and internal fixation of scoliosis under general anesthesia were selected. According to the computer random digital table, 15 cases were randomly divided into two groups: control group (Cell Saver5-treated autotransfusion) and experimental group (Cell Saver5-treated autologous blood was filtered by Pall LipiGuard-SB1 blood filter and re-injected). The blood before operation was collected, the autogenous blood was washed, the autogenous blood was filtered (limited to the experimental group), the blood in the body before transfusion, the blood in vivo 2 hours after transfusion, the blood in vivo 24 hours after transfusion and the blood in body 72 hours after transfusion were measured respectively, and the blood routine was measured respectively. IL-6,IL-10 and NE levels. Postoperative recovery and complications were recorded. Statistical processing: all data are described by mean 鹵standard deviation or median (25% quartile, 75% quartile). SAS9.2 statistical software was used to test the intra-group and inter-group differences using the generalized linear mixed model (Genaralized linear mixed model). Results: the WBC counts in both groups were higher than those before operation (P0.001), and decreased after washing and filtering (P0.001). The percentage of neutrophils in the filtered blood of the experimental group was lower than that of the washed blood (P < 0. 013). The level of IL-6 in experimental group was lower than that in control group (p < 0. 001). No postoperative complications were found in the experimental group, 1 case of wound liquefaction and 1 case of pulmonary infection in the control group. Conclusion: autologous blood filter can effectively reduce the number of leukocytes, the percentage of neutrophil and the level of IL-6 in autologous blood, which can reduce the degree of systemic inflammatory reaction after operation.
【學(xué)位授予單位】：北京協(xié)和醫(yī)學(xué)院
【學(xué)位級(jí)別】：博士
【學(xué)位授予年份】：2013
【分類號(hào)】：R614

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相關(guān)期刊論文 前1條

1 李景文;龍村;孫鵬;劉凱;考力;;經(jīng)白細(xì)胞濾器過濾后的體外循環(huán)余血回輸對(duì)患者炎性細(xì)胞因子的影響[J];中國(guó)體外循環(huán)雜志;2010年02期

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本文編號(hào)：2469140