自体血液回输对成人心脏瓣膜置换术患者血液携氧功能的影响

doi:10.3760/cma.j.issn.2095-7041.2017.04.011

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摘要目的探讨自体血回输对体外循环下心瓣膜置换术患者血液携氧功能的影响。方法抽选河南省胸科医院心外科2014年4月—2016 年1月收治的90例首次接受心脏手术的心脏瓣膜病患者作为研究对象,随机分为观察组和对照组。观察组45例采用自体血液回收技术;对照组45例不采用自体血液回收技术,直接使用库血。检测并比较两组术前(T₁)、术毕(T₂)、术后24 h(T₃)、术后第7天(T₄)的动脉血液携氧功能指标,包括RBC、Hb、红细胞比容(Hct)、氧合指数、红细胞内2,3-二磷酸甘油酸浓度(2,3-DPG) 、红细胞变形指数(RCD)。结果观察组与对照组在T₂时点的RBC分别为(3.59±0.37)×10¹²/L和(3.64±0.44)×10¹²/L,Hb分别为(101.26±19.54)g/L和(102.38±20.05)g/L,Hct分别为(0.35±0.12)和(0.34±0.13),较组内T₁降低,差异均有统计学意义(P值均＜0.05);但T₃和T₄与组内T₁时点比较,差异均无统计学意义(P值均>0.05),且组间各时点比较差异均无统计学意义(P值均>0.05)。观察组在T₁~T₄的氧合指数分别为(415.14±51.24)、(348.33±39.45)、(317.59±33.36)和(377.16±45.44) mmHg(1 mmHg=0.133 kPa),对照组则分别为(418.16±52.18)、(344.44±42.20)、(320.65±35.11)和(375.24±43.94) mmHg,组间各时点比较差异均无统计学意义(P值均>0.05),但组内术后各时点与术前比较差异均有统计学意义(P值均＜0.01)。两组间及组内术前术后红细胞2,3-DPG比较差异均无统计学意义(P值均>0.05)。两组RCD术后较术前的有明显增高(P值均＜0.01),而组间比较差异均无统计学意义(P值均>0.05)。结论应用自体血液回输对成人心脏瓣膜置换术中血液携氧功能无明显损伤,可减少库血的使用,具有较高的临床意义。

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	王龙
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关键词 ：输血,自体, 体外循环, 心瓣膜置换术, 携氧功能

Abstract：Objective To investigate the effect of autologous blood transfusion on blood oxygen carrying capacity in patients undergoing cardiopulmonary bypass.Methods Ninety patients with heart valve disease who underwent cardiac surgery for the first time in Cardiac Surgery of Henan Province Chest Hospital from April 2014 to January 2010 were randomized to study. Forty-five patients of observation group used autologous blood recovery technology, and 45 patients did not use autologous blood recovery technology, the direct use of library blood as the control group. The arterial blood oxygenation function indexes were measured before operation(T₁), at the postoperation moment(T₂), 24 hours after operation(T₃) and 7 days after operation(T₄). These indexes included RBC, hemoglobin (HGB), hematocrit (Hct), oxygenation index(OI), erythrocyte 2,3-diphosphoglycerate concentration (2,3-DPG) and erythrocyte deformation index (RCD).Results The levels of RBC in the observation group and the control group at the T₁ were (3.59±0.37) × 10¹²/L and (3.64±0.44) × 10¹²/L, and the levels of HGB were (101.26±19.54) g/L and (102.38±20.05)g/L , the levels of Hct were (0.35±0.12) L/L and (0.34±0.13) L/L, respectively, which were significantly lower than those before operation (all P values<0.01), but there was no significant difference between the two groups (all P values>0.05). The OI in the observation group at the T₁, T₂, T₃, T₄ were (415.14±51.24), (348.33±39.45), (317.59±33.36) and (377.16±45.44) mmHg, the control group were (418.16±52.18), (344.44±42.20), (320.65±35.11) and (375.24±43.94) mmHg, respectively. There was no significant difference between the two groups (all P values>0.05),but there was significant difference compared with the T₂ or T₃ or T₄ and T₁ within every group(all P values<0.01). There was no significant difference in 2,3-DPG between the two groups before and after the operation(all P values>0.05). Two groups were significantly higher than preoperative RCD (all P values<0.01), but no significant difference between the groups (all P values>0.05).Conclusions The use of autologous blood recovery in adult heart valve replacement surgery blood oxygen carrying function doesnt have significant damage, which reduces the intensity of the blood supply and has important significance.

Key words： Blood transfusion, autologous Extracorporeal circulation Heart valve replacement Oxygen carrying function

收稿日期: 2016-12-30

通讯作者: 王龙, Email: x8962701w@126.com

引用本文:

王龙, 高夏, 乔利阳. 自体血液回输对成人心脏瓣膜置换术患者血液携氧功能的影响[J]. 中华解剖与临床杂志, 2017, 22(4): 312-316.
Wang Long, Gao Xia, Qiao Liyang.. Effects of autologous blood transfusion on blood oxygen carrying function in adult patients undergoing cardiac valve replacement. Chinese Journal of Anatomy and Clinics, 2017, 22(4): 312-316.

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