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  本文關鍵詞： 自體血回收機 脊柱手術 紅細胞形態(tài) 2 3-DPG 肝素 游離血紅蛋白　出處：《中南大學》2013年碩士論文　論文類型：學位論文

【摘要】：目的：評價脊柱手術中血液回收的質(zhì)量,對比觀察國產(chǎn)京精3000P型和進口Haemonetics Cell Saver5+型自體血回收機在脊柱手術中回收血液的質(zhì)量。 方法：選擇擇期行脊柱手術的患者40例,隨機分為兩組,CS5+組和3000P組,每組20例。分別使用相應的進口Haemonetics Cell Saver5+型和國產(chǎn)京精3000P型自體血回收機進行洗滌式血液回收。觀察兩組洗滌前、后血紅細胞的形態(tài),比較紅細胞畸形率；用分光光度法測定紅細胞中2,3-DPG的含量,評估紅細胞的攜氧功能；測定血常規(guī)、血氣、游離血紅蛋白和肝素的含量；并與術前動脈血和CPDA-1保養(yǎng)液保存三周以上的庫存血比較。 結果：1、與術前動脈血相比,兩組洗滌前、后血紅細胞畸形率較高(p0.01),但兩組洗滌后血紅細胞畸形率較洗滌前血明顯降低(p0.01),且明顯低于庫存血紅細胞畸形率(p0.01)。兩組間紅細胞畸形率無明顯差異(p0.05)。 2、兩組洗滌后血紅細胞中2,3-DPG含量較洗滌前血降低(p0.01),但與術前動脈血相比無明顯差異(p0.05),且明顯高于庫存血紅細胞中2,3-DPG含量(p0.01)。兩組間紅細胞中2,3-DPG含量無明顯差異(p0.05)。 3、CS5+組和3000P組洗滌后血的Hct分別為38.9%±7.5%和34.7%±9.7%；Hb分別為129.2±27.3g/l和114.8±27.4g/l；游離血紅蛋白含量分別為1.048±0.507g/l和1.147±0.432g/l；殘余肝素含量分別為0.014±0.013IU/ml和0.016±0.011IU/ml; K+分別為4.51±0.24mmol/l和4.67±0.32mmol/l。 4、CS5+組和3000P組的紅細胞回收率分別為77.14%±13.97%和74.62%±9.71%；游離血紅蛋白的清除率分別為95.46%±1.81%和95.53%±1.85%；肝素的清除率分別為99.77%±0.14%和99.62%±0.19%；K+的清除率分別為84.49%±4.27%和84.69%±6.25%。兩組間紅細胞回收率和各物質(zhì)清除率均沒有統(tǒng)計學差異(p0.05)。 結論：1、兩種自體血回收機在回收和清洗過程中對紅細胞的形態(tài)均有一定的影響,但洗滌后得到的紅細胞形態(tài)較好,且優(yōu)于庫存血。 2、經(jīng)兩種白體血回收機清洗后血的紅細胞中2,3-DPG含量均有所降低,但與術前動脈血一樣具備良好的攜氧功能,且優(yōu)于庫存血。 3、脊柱手術中兩種自體血回收機均能得到較好質(zhì)量的濃縮紅細胞,對FHb、肝素、K+離子等清除完全,符合臨床標準。 4、國產(chǎn)京精3000P型和Haemonetics Cell Saver5+型自體血回收機在脊柱手術中血液回收的質(zhì)量以及處理血液的效果相近。
[Abstract]:Objective: to evaluate the quality of blood recovery in spinal surgery, and to observe the quality of autogenous blood recovery in spinal surgery by domestic Jingjing 3000P type and imported Haemonetics Cell Saver5 type autologous blood recovery machine. Methods: forty patients undergoing spinal surgery were randomly divided into two groups: CS5 group and 3000P group. 20 patients in each group were treated with Haemonetics Cell Saver5 and Jingjing 3000P autologous blood recovery machine respectively. The morphology of red blood cells before and after washing was observed and the deformity rate of red blood cells was compared between the two groups. The contents of 2n3-DPG in erythrocytes were determined by spectrophotometry to evaluate the oxygen-carrying function of erythrocytes, the contents of blood routine, blood gas, free hemoglobin and heparin were measured, and the results were compared with those stored in arterial blood and CPDA-1 maintenance solution for more than three weeks before operation. Results compared with preoperative arterial blood, the two groups, before washing, The deformity rate of hind blood red blood cell was higher than that before washing, but the deformity rate of red blood cell after washing in the two groups was significantly lower than that before washing, and was significantly lower than that in the stock. There was no significant difference between the two groups in the deformity rate of red blood cell (P 0.05). (2) after washing, the content of 2o 3-DPG in red blood cells of the two groups was lower than that before washing, but there was no significant difference between the two groups compared with the arterial blood before washing, and the content of 2F3 DPG was significantly higher than that of the stored red blood cells (P 0.01). There was no significant difference between the two groups in the contents of 2o 3-DPG in red blood cells (P 0.05). 3The Hct of washed blood in CS5 group and 3000P group was 38.9% 鹵7.5% and 34.7% 鹵9.7 g / L, respectively, the HB was 129.2 鹵27.3 g / l and 114.8 鹵27.4 g / l, the content of free hemoglobin was 1.048 鹵0.507 g / l and 1.147 鹵0.432 g / l, the residual heparin content was 0.014 鹵0.013 渭 mol / ml and 0.016 鹵0.011 mol / ml, K was 4.51 鹵0.24 mmol / ml and 4.67 鹵0.32 mmol / L, respectively. 4 the erythrocyte recovery rates of CS5 group and 3000P group were 77.14% 鹵13.97% and 74.62% 鹵9.71, the clearance rates of free hemoglobin were 95.46% 鹵1.81% and 95.53% 鹵1.85, the clearance rates of heparin were 99.77% 鹵0.14% and 99.62% 鹵0.19kirk, respectively, 84.49% 鹵4.27% and 84.69% 鹵6.25.The erythrocyte recovery rate and the cleaning rate of each substance between the two groups were 84.49% 鹵4.27% and 84.69% 鹵6.25.The clearance rates of heparin were 84.49% 鹵4.27% and 84.69% 鹵6.25respectively. There was no statistical difference in the removal rate (P 0.05). ConclusionTwo kinds of autologous blood collectors have certain influence on the morphology of red blood cells in the process of recovery and washing, but the red blood cells obtained after washing are better than those of blood stored in stock. 2. After washing with two kinds of white body blood collectors, the contents of 23 DPG in erythrocytes were decreased, but they had the same oxygen carrying function as preoperative arterial blood, and were superior to the blood stored in stock. 3. Two kinds of autologous blood recovery machines can get better quality concentrated red blood cells in spinal surgery, which can eliminate FHb and heparin K ion completely and meet the clinical standard. 4. The quality of blood recovery and the effect of blood treatment were similar to those of domestic Jingjing 3000P and Haemonetics Cell Saver5 autologous blood collectors during spinal surgery.
【學位授予單位】：中南大學
【學位級別】：碩士
【學位授予年份】：2013
【分類號】：R612

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