中国医师进修杂志
中國醫師進脩雜誌
중국의사진수잡지
CHINESE JOURNAL OF POSTGRADUATES OF MEDICINE
2014年
26期
26-29
,共4页
白细胞去除术%输血,自体%免疫%红细胞%炎症
白細胞去除術%輸血,自體%免疫%紅細胞%炎癥
백세포거제술%수혈,자체%면역%홍세포%염증
Leukapheresis%Blood transfusion,autologous%Immunity%Erythrocytes%Inflammation
目的 评价滤除白细胞自体血回输对围手术期患者红细胞免疫功能及全身炎性反应的影响.方法 选择行自体血回输患者60例,采用随机数字表法将患者分为对照组和观察组,每组30例.对照组进行常规自体血回收回输,观察组自体血滤除白细胞后再输给患者.两组患者分别于麻醉前(T1)、术毕(T2)、术后12 h(T3)、术后36 h(T4)采集中心静脉血标本,采用改良郭峰法检测红细胞C3b受体花环率(RBC-C3bRR)、红细胞免疫复合物花环率(RBC-ICR),并行白细胞及中性粒细胞计数;酶联免疫吸附试验法检测血浆肿瘤坏死因子α (TNF-α)、白细胞介素6(IL-6)、丙二醛(MDA)浓度.结果 与对照组比较,观察组T2～T4时血浆IL-6、TNF-α、MDA浓度降低[T2:(17.8±1.6)ng/L比(20.8±1.3) ng/L、(17.4±2.3) ng/L比(23.1±2.1)ng/L、(4.31 ±0.33) nmol/L比(4.64±0.73)nmol/L;T3:(21.2±2.0) ng/L比(24.3 ± 2.4) ng/L、(12.3±2.1) ng/L比(18.6± 1.9) ng/L、(3.97±0.35)nmol/L比(4.43 ±0.64) nmol/L;T4:(22.0 ± 1.3) ng/L比(28.4±1.5) ng/L、(10.6±1.7) ng/L比(14.6±2.2)ng/L、(3.45±0.57) nmol/L比(3.95±0.40) nmol/L],T3～T4时RBC-C3bRR升高[T3:(15.3±1.3)个/100个RBC比(12.8±1.5)个/100个RBC;T4:(15.8 ±1.2)个/100个RBC比(13.0±1.5)个/100个RBC],差异均有统计学意义(P＜0.05),各时间点RBC-ICR、白细胞、中性粒细胞计数比较差异无统计学意义(P＞0.05).结论 滤除白细胞自体血回输有助于改善围手术期患者红细胞免疫功能,其机制可能与降低全身炎性反应有关.
目的 評價濾除白細胞自體血迴輸對圍手術期患者紅細胞免疫功能及全身炎性反應的影響.方法 選擇行自體血迴輸患者60例,採用隨機數字錶法將患者分為對照組和觀察組,每組30例.對照組進行常規自體血迴收迴輸,觀察組自體血濾除白細胞後再輸給患者.兩組患者分彆于痳醉前(T1)、術畢(T2)、術後12 h(T3)、術後36 h(T4)採集中心靜脈血標本,採用改良郭峰法檢測紅細胞C3b受體花環率(RBC-C3bRR)、紅細胞免疫複閤物花環率(RBC-ICR),併行白細胞及中性粒細胞計數;酶聯免疫吸附試驗法檢測血漿腫瘤壞死因子α (TNF-α)、白細胞介素6(IL-6)、丙二醛(MDA)濃度.結果 與對照組比較,觀察組T2～T4時血漿IL-6、TNF-α、MDA濃度降低[T2:(17.8±1.6)ng/L比(20.8±1.3) ng/L、(17.4±2.3) ng/L比(23.1±2.1)ng/L、(4.31 ±0.33) nmol/L比(4.64±0.73)nmol/L;T3:(21.2±2.0) ng/L比(24.3 ± 2.4) ng/L、(12.3±2.1) ng/L比(18.6± 1.9) ng/L、(3.97±0.35)nmol/L比(4.43 ±0.64) nmol/L;T4:(22.0 ± 1.3) ng/L比(28.4±1.5) ng/L、(10.6±1.7) ng/L比(14.6±2.2)ng/L、(3.45±0.57) nmol/L比(3.95±0.40) nmol/L],T3～T4時RBC-C3bRR升高[T3:(15.3±1.3)箇/100箇RBC比(12.8±1.5)箇/100箇RBC;T4:(15.8 ±1.2)箇/100箇RBC比(13.0±1.5)箇/100箇RBC],差異均有統計學意義(P＜0.05),各時間點RBC-ICR、白細胞、中性粒細胞計數比較差異無統計學意義(P＞0.05).結論 濾除白細胞自體血迴輸有助于改善圍手術期患者紅細胞免疫功能,其機製可能與降低全身炎性反應有關.
목적 평개려제백세포자체혈회수대위수술기환자홍세포면역공능급전신염성반응적영향.방법 선택행자체혈회수환자60례,채용수궤수자표법장환자분위대조조화관찰조,매조30례.대조조진행상규자체혈회수회수,관찰조자체혈려제백세포후재수급환자.량조환자분별우마취전(T1)、술필(T2)、술후12 h(T3)、술후36 h(T4)채집중심정맥혈표본,채용개량곽봉법검측홍세포C3b수체화배솔(RBC-C3bRR)、홍세포면역복합물화배솔(RBC-ICR),병행백세포급중성립세포계수;매련면역흡부시험법검측혈장종류배사인자α (TNF-α)、백세포개소6(IL-6)、병이철(MDA)농도.결과 여대조조비교,관찰조T2～T4시혈장IL-6、TNF-α、MDA농도강저[T2:(17.8±1.6)ng/L비(20.8±1.3) ng/L、(17.4±2.3) ng/L비(23.1±2.1)ng/L、(4.31 ±0.33) nmol/L비(4.64±0.73)nmol/L;T3:(21.2±2.0) ng/L비(24.3 ± 2.4) ng/L、(12.3±2.1) ng/L비(18.6± 1.9) ng/L、(3.97±0.35)nmol/L비(4.43 ±0.64) nmol/L;T4:(22.0 ± 1.3) ng/L비(28.4±1.5) ng/L、(10.6±1.7) ng/L비(14.6±2.2)ng/L、(3.45±0.57) nmol/L비(3.95±0.40) nmol/L],T3～T4시RBC-C3bRR승고[T3:(15.3±1.3)개/100개RBC비(12.8±1.5)개/100개RBC;T4:(15.8 ±1.2)개/100개RBC비(13.0±1.5)개/100개RBC],차이균유통계학의의(P＜0.05),각시간점RBC-ICR、백세포、중성립세포계수비교차이무통계학의의(P＞0.05).결론 려제백세포자체혈회수유조우개선위수술기환자홍세포면역공능,기궤제가능여강저전신염성반응유관.
Objective To investigate the effect of leukocyte-depleted intraoperative savaged blood on erythrocyte immunity and systemic inflammatory response during perioperative period patients.Methods Sixty patients required blood salvage were randomly divided into two groups by random digits table method with 30 cases each.The patients in control group were given routine autologous blood transfusion,while in observation group,the salvaged blood was filtered with a leukocyte depleting filter placed in the reinfusion circuit.Blood samples were collected from the central vein before anesthesia (T1),at the end of surgery(T2),and at 12 h (T3) and 36 h (T4) after operation in two groups.The rosette rates of RBC-C3b receptors (RBC-C3bRR) and RBC-immune complex (RBC-ICR) were determined.The leukocyte and neutrophil were counted.The plasma levels of interleukin-6(IL-6),tumor necrosis factor-alpha(TNF-α) and malondialdehyde (MDA) were measured.Results Compared with control group,the plasma level of IL-6,TNF-α,MDA at T2-T4 in observation group was decreased[T2:(17.8 ± 1.6) ng/L vs.(20.8 ± 1.3) ng/L,(17.4 ± 2.3) ng/L vs.(23.1 ± 2.1) ng/L,(4.31 ± 0.33) nmol/L vs.(4.64 ± 0.73) nmol/L;T3:(21.2 ± 2.0) ng/L vs.(24.3 ± 2.4) ng/L,(12.3 ±2.1) ng/L vs.(18.6 ±1.9) ng/L,(3.97 ±0.35) nmol/L vs.(4.43 ±0.64) nmol/L;T4:(22.0 ± 1.3) ng/L vs.(28.4 ± 1.5) ng/L,(10.6 ± 1.7) ng/L vs.(14.6 ± 2.2) ng/L,(3.45 ± 0.57) nmol/L vs.(3.95 ± 0.40) nmol/L],RBC-C3bRR at T3-T4 in observation group was increased [T3:(15.3 ± 1.3)/100 RBC vs.(12.8 ± 1.5)/100 RBC ;T4:(15.8 ± 1.2)/100 RBC vs.(13.0 ± 1.5)/100 RBC],and there were significant differences (P ＜0.05).There was no significant difference in RBC-ICR,the leukocyte and neutrophil between two groups (P ＞ 0.05).Conclusion Leukocyte-deleted intraoperative salvaged blood is helpful to improve the erythrocyte immunity during perioperative period in patients,and the decrease in the systemic inflammatory response may be involved in the mechanism.
