CAJ | 학술논문

目的观察洗涤式自体血回输对行非体外冠状动脉旁路移植术(OP-CABG)的糖尿病患者红细胞渗透脆性的影响.方法 2011年9月至2012年12月宁波市医疗中心李惠利医院麻醉科择期在洗涤式自体血回输下行OP-CABG的患者60例,根据患者有无糖尿病分为对照组(C组,n=30)和糖尿病组(D组,n=30).比较红细胞回收率、术前及洗涤前后红细胞溶血率和回收血静置0、4、6、12、24 h后的游离血红蛋白和血钾水平.结果两组患者红细胞回收率比较差异无统计学意义(C组82.6%±5.6%,D组80.9%±6.2%,P＞0.05);同一处理条件下,D组患者术前、洗涤前溶血率在0.36%~0.68%低渗NaCl浓度溶液中均高于C组(术前0.36%:D组84.9%± 6.7% C组78.7%± 4.6%,P=0.003;术前0.68%:D组9.0%± 4.5% C组1.9%± 0.8%,P=0.000;洗涤前0.36%:D组80.6%±4.9% C组78.0%±5.8%,P=0.000;洗涤前0.68%:D组11.0%± 3.4% C组 2.4%± 0.9%,P=0.000),洗涤后差异无统计学意义;洗涤后血液随静置时间延长,两组患者游离血红蛋白和血钾浓度均逐渐升高,与洗涤后0 h比较差异均有统计学意义(均P<0.05),但在同一洗涤时间点,上述指标在两组之间差异无统计学意义.结论洗涤式自体血回输并未额外加重行OP-CABG的糖尿病患者红细胞损伤;回收血液洗涤后应尽早输回患者体内.
목적 관찰세조식자체혈회수대행비체외관상동맥방로이식술(OP-CABG)적당뇨병환자홍세포삼투취성적영향.방법 2011년9월지2012년12월저파시의료중심리혜리의원마취과택기재세조식자체혈회수하행OP-CABG적환자60례,근거환자유무당뇨병분위대조조(C조,n=30)화당뇨병조(D조,n=30).비교홍세포회수솔、술전급세조전후홍세포용혈솔화회수혈정치0、4、6、12、24 h후적유리혈홍단백화혈갑수평.결과 량조환자홍세포회수솔비교차이무통계학의의(C조82.6%±5.6%,D조80.9%±6.2%,P＞0.05);동일처리조건하,D조환자술전、세조전용혈솔재0.36%~0.68%저삼NaCl농도용액중균고우C조(술전0.36%:D조84.9%± 6.7% C조78.7%± 4.6%,P=0.003;술전0.68%:D조9.0%± 4.5% C조1.9%± 0.8%,P=0.000;세조전0.36%:D조80.6%±4.9% C조78.0%±5.8%,P=0.000;세조전0.68%:D조11.0%± 3.4% C조 2.4%± 0.9%,P=0.000),세조후차이무통계학의의;세조후혈액수정치시간연장,량조환자유리혈홍단백화혈갑농도균축점승고,여세조후0 h비교차이균유통계학의의(균P<0.05),단재동일세조시간점,상술지표재량조지간차이무통계학의의.결론 세조식자체혈회수병미액외가중행OP-CABG적당뇨병환자홍세포손상;회수혈액세조후응진조수회환자체내.
Objective To explore the effects of washed autologous blood transfusion on the recovery and hemolysis of erythrocytes from diabetic patients subjected to off-pump coronary artery bypass grafting (OP-CABG). Methods A total of Sixty patients were included in this study. The patients were assigned as two groups:control (C,n=30) ,and diabetic group (D,n=30). Samples were taken from preoperation, prior to and after disposal of centrifuging and washing to determine the recovery and fragility of erythrocytes. Free hemoglobin and extracellular potassium were measured at 0, 4, 6, 12, 24 h after washing.Results The erythrocytic recovery did not have significant difference between two groups (C group 82.6%±5.6%,D group 80.9%±6.2%,P＞0.05).Under the same processing,the erythrocyte fragility in the diabetic group were significantly higher than the control group in preoperation and beforewashing (Preoperation 0.36%:D group 84.9%± 6.7% C group 78.7%± 4.6%,P=0.003;Preoperation 0.68%:D group 9.0%± 4.5% C group 1.9%± 0.8%,P=0.000;Beforewashing 0.36%:D group 80.6%± 4.9% C group 78.0%± 5.8%,P=0.000;Beforewashing 0.68%:D group 11.0%± 3.4% C group 2.4%± 0.9% ,P=0.000). However, after washing there were no significant differences of erythrocyte fragility between groups. Free hemoglobin and blood potassium at 4, 6, 12, 24 h after washing were significantly increased (P<0.05) in a time-dependent manner in the two groups.But there was no obvious difference in the interior-group at the same time point.Conclusions Autotransfusion has no significant extra damage on erythrocytes from diabetic patitents undergoing OP-CABG, and the salvaged blood should be transfused as soon as possible to reduce hemolysis.