CAJ | 학술논문

目的评价储血器内预充甘露醇腺嘌呤磷酸二氢钠(MAP)溶液对患者自体回收血红细胞损伤的影响.方法取150例脊柱手术患者术中自体回收血样150份,采用随机数字表法,分为5组(n=30):N组、N1组、N2组、M1组和M2组.手术开始前,N组储血器内不预充任何液体,N1组、N2组、M1组和M2组分别在储血器内预充生理盐水100、200 ml、MAP溶液100、200 ml.自体回收血洗涤后,取血样行红细胞渗透脆性实验,计算在不同浓度的低渗NaCl溶液中红细胞的溶血率.分别于洗涤血样静置即刻(T0)、1 h(T1)和2 h(T2)时检测洗涤血样上清液中游离血红蛋白(rHb)的浓度.结果与N组和N1组比较,M1组在NaCl浓度为0.48％～ 0.68％时洗涤血红细胞溶血率降低,T1时FHb浓度降低(P＜0.01),T2时差异无统计学意义(P＞0.05).与N组和N2组比较,M2组在NaCl浓度为0.48％～0.68％时洗涤血红细胞溶血率降低,T1.2时FHb浓度降低(P＜0.01).与M1组比较,M2组T2时FHb降低(P＜0.01).结论储血器内预充MAP溶液可减轻患者自体回收血红细胞损伤,且预充MAP溶液200 ml时的效果优于预充100 ml.
목적 평개저혈기내예충감로순선표령린산이경납(MAP)용액대환자자체회수혈홍세포손상적영향.방법 취150례척주수술환자술중자체회수혈양150빈,채용수궤수자표법,분위5조(n=30):N조、N1조、N2조、M1조화M2조.수술개시전,N조저혈기내불예충임하액체,N1조、N2조、M1조화M2조분별재저혈기내예충생리염수100、200 ml、MAP용액100、200 ml.자체회수혈세조후,취혈양행홍세포삼투취성실험,계산재불동농도적저삼NaCl용액중홍세포적용혈솔.분별우세조혈양정치즉각(T0)、1 h(T1)화2 h(T2)시검측세조혈양상청액중유리혈홍단백(rHb)적농도.결과 여N조화N1조비교,M1조재NaCl농도위0.48％～ 0.68％시세조혈홍세포용혈솔강저,T1시FHb농도강저(P＜0.01),T2시차이무통계학의의(P＞0.05).여N조화N2조비교,M2조재NaCl농도위0.48％～0.68％시세조혈홍세포용혈솔강저,T1.2시FHb농도강저(P＜0.01).여M1조비교,M2조T2시FHb강저(P＜0.01).결론 저혈기내예충MAP용액가감경환자자체회수혈홍세포손상,차예충MAP용액200 ml시적효과우우예충100 ml.
Objective To evaluate the effect of prefilling blood reservoir with mannitol-adeninephosphate MAP) solution on the damage to erythrocytes in intraoperative salvaged blood in patients.Methods One hundred and fifty blood samples were collected from 150 patients who were scheduled for elective spinal surgery requiring blood salvage,and were equally and randomly divided into 5 groups (n =30 each) using a random number table:group N,group N1,group N2,group M1 and group M2.The blood reservoir was not prefilled before surgery in group N,while the blood reservoirs in N1,N2,M1 and M2 groups were prefilled with normal saline (NS) 100 ml,NS 200 ml,MAP solution 100 ml and MAP solution 200 ml,respectively.Blood sauples were obtained for erythrocyte osmotic fragility test after the salvaged blood was washed,and hemolysis rates in different concentrations of hypotonic NaCl solution were calculated.The concentration of free hemoglobin in the clear supernatant liquid (FHb) of washed blood placed for 0 h (T0),1 h (T1) and 2 h (T2) were detected.Results Compared with N and N1 groups,the hemolysis rate of washed erythrocytes under 0.48％ 0.68％ NaCl solutions was significantly decreased,the concentration of FHb at T1 was decreased,and no significant change was found in FHb at T2 in group M1.Compared with N and N2 groups,the haemolysis rates of washed erythrocytes under 0.48％-0.68％ NaCl solutions were significantly decreased,and the concentrations of FHb at T1,2 were decreased in group M2.The concentration of FHb was significantly lower at T2 in group M2 than in group M1.Conclusion Prefilling blood reservoir with MAP solution can mitigate the damage to erythrocytes in the intraoperative salvaged blood in patients,and the efficacy of prefilling of 200 ml is superior to that of prefilling of 100 ml.