洗涤回收式自体输血对膝关节、髋关节置换术患者血栓弹力图及免疫功能的影响

目的探讨洗涤回收式自体输血对膝关节、髋关节置换术患者血栓弹力图及免疫功能的影响。 方法选取2019年1月至12月甘肃省中医院骨科收治的膝关节、髋关节置换术中出血400~1 000 ml，回收输血量400~600 ml的患者186例为观察组，并选择同期只接受异体输血的患者162例为对照组。对两组患者输血前与输血后1 d、5 d的血红蛋白(Hb)、红细胞计数(RBC)、红细胞比容(HCT)、血小板(PLT)、血栓弹力图包括凝血反应时间(R)、最大振幅(MA)、血凝块形成时间(K)、凝固角度(α)]及细胞免疫功能(包括CD3⁺CD4⁺T细胞、CD3⁺CD8⁺T细胞、CD16⁺CD56⁺NK细胞)水平进行检测并比较。 结果输血后1 d，观察组Hb(112.57±14.32)g/L、HCT(34.10±3.32)%、RBC(3.12±0.53)×10¹²/L、PLT(125±31)×10⁹/L与对照组Hb(108.35±12.84)g/L、HCT(33.52±3.04)%、RBC(2.91±0.42)×10¹²/L、PLT(123±40)×10⁹/L比较，均差异无统计学意义(t＝0.36，1.21，1.37，1.94；均P>0.05)；输血后5 d，观察组Hb(122.52±13.70)g/L、HCT(40.12±3.80)%、RBC(3.91±0.45)×10¹²/L、PLT(135±39)×10⁹/L与对照组Hb(118.31±13.91)g/L、HCT(35.50±3.70)%、RBC(3.14±0.61)×10¹²/L、PLT(127±31)×10⁹/L比较，均差异有统计学意义(t＝7.01，5.58，5.72，7.61；均P<0.05)。输血后1 d，观察组R(5.97±0.31)min、MA(56.73±2.24)mm、K(2.57±0.10)min、α(59.88±1.73)°与对照组R(6.07±0.30)min、MA(57.68±1.78)mm、K(2.70±0.52)min、α(61.12±3.09)°比较，均差异无统计学意义(t＝2.02，0.90，0.66，0.99；均P>0.05)。输血后5 d，观察组R(6.62±0.59)min、MA(63.81±0.86)mm、K(2.95±0.19)min、α(61.12±2.36)°与对照组R(6.82±1.21)min、MA(62.99±1.88)mm、K(2.82±0.18)min、α(60.50±2.07)°比较，均差异无统计学意义(t＝1.70，1.04，1.33，0.56；均P>0.05)。流式细胞分析表明，输血后1 d，观察组患者CD3⁺CD4⁺T细胞的水平(33.66±2.10)高于对照组(29.88±1.97)，差异有统计学意义(t＝3.72，P<0.01)；输血后5 d，观察组CD3⁺CD4⁺T细胞(35.92±0.79)、CD3⁺CD8⁺T细胞(21.82±1.61)、CD16⁺CD56⁺NK细胞(1.68±0.14)水平均高于对照组(29.83±2.11、20.53±2.71、1.03±0.13)，均差异有统计学意义(t＝7.66，6.57，9.58；均P<0.01)。 结论与异体输血比较，洗涤回收式自体输血不影响膝关节置换、髋关节置换患者血栓弹力图R、MA、K、α，可以提高患者的细胞免疫功能。

The effect of washing autotransfusion salvage on thromboelastography and immune function in patients undergoing knee and hip arthroplasty surgery

ObjectiveTo explore the effect of washing autotransfusion salvage on thromboelastography and immune function of patients undergoing knee and hip arthroplasty surgery. MethodsA total of 186 patients with 400-1 000 ml bleeding and 400-600 ml of recovered blood transfusion during knee and hip arthroplasty surgery who were admitted to the Orthopedics Department of Gansu Provincial Hospital of Traditional Chinese Medicine from January to December 2019 were selected as the observation group, and at the same time 162 patients with allogeneic transfusion were selected as the control group. The postoperative hemoglobin (Hb), red blood cell count (RBC), hematocrit (HCT), thromboelastography, including reaction time (R), maximum amplitude (MA), blood clot formation time (K), α and cellular immune function (including CD3⁺ CD4⁺ T cells, CD3⁺ CD8⁺ T cells, CD16⁺ CD56⁺ NK cells) levels of the two groups of patients before and 1 d, 5 d after blood transfusion were tested and compared. ResultsOne day after blood transfusion, Hb (112.57±14.32)g/L, HCT (34.10±3.32)%, RBC (3.12±0.53)×10¹²/L, PLT (125±31)×10⁹/L of the observation group were compared with those of the control group Hb (108.35±12.84)g/L, HCT (33.52±3.04)%, RBC (2.91±0.42)×10¹²/L, PLT (123±40)×10⁹/L], the differences were not statistically significant (t=0.36, 1.21, 1.37, 1.94, all P>0.05). Five days after blood transfusion, Hb, HCT, RBC, PLT (122.52±13.70)g/L, (40.12±3.80)%, (3.91±0.45)×10¹²/L, (135±39)×10⁹/L] levels of the observation group were compared with those of the control group Hb (118.31±13.91)g/L, HCT (35.50±3.70)%, RBC (3.14±0.61)×10¹²/L, PLT (127±31)×10⁹/L], the differences were statistically significant (t=7.01, 5.58, 5.72, 7.61, all P<0.05). One day after blood transfusion, the R, MA, K, α (5.97±0.31)min, (56.73±2.24)mm, (2.57±0.10)mm, (59.88±1.73)°] of the observation group were compared with those in the control group R (6.07±0.30)min, MA (57.68±1.78)mm, K (2.70±0.52)min, α (61.12±3.09)°], showing no statistically significant differences (t=2.02, 0.90, 0.66, 0.99, all P>0.05). Five days after blood transfusion, the R, MA, K, α (6.62±0.59)min, (63.81±0.86)mm, (2.95±0.19)min, (61.12±2.36)°] of the observation group were compared with those of the control group R (6.82±1.21)min, MA (62.99±1.88)min, K (2.82±0.18)min, α (60.50±2.07)°], showing no statistically significant differences (t=1.70, 1.04, 1.33, 0.56, all P>0.05). Flow cytometry analysis showed that 1 day after blood transfusion, the level of CD3⁺ CD4⁺ T cells in the observation group (33.66±2.10) was significantly higher than that in the control group (29.88±1.97) , the difference was statistically significant (t=3.72, P<0.01). Five days after blood transfusion, the levels of CD3⁺ CD4⁺ T cells (35.92±0.79), CD3⁺ CD8⁺ T cells (21.82±1.61), and CD16⁺ CD56⁺ NK cells (1.68±0.14) of the observation group were significantly higher than those of the control group (29.83±2.11, 20.53±2.71, 1.03±0.13), the differences were statistically significant (t=7.66, 6.57, 9.58, all P<0.01). ConclusionCompared with allogeneic transfusion, washing autotransfusion salvage does not affect the R, MA, K, α of thromboelastography of patients undergoing knee and hip arthroplasty surgery, and could improve the patient′s cellular immune function.