回收式自体输血对骨科手术患者凝血及免疫功能的影响

目的探讨回收式自体输血对机体凝血状态和T淋巴细胞亚群，NK细胞功能的影响。方法选择骨科大手术病人40例，随机分为回收式自体输血组和异体输血组。分别取术前、输血后1h及输血后24h的静脉血，测定血常规，部分凝血酶原时间（APTT），凝血酶原时间（PT），纤维蛋白原（FIB）及活化凝血时间（ACT），同时应用流式细胞仪测定输血后第1天、第5天两组病人T淋巴细胞亚群CD3^＋、CD4^＋、CD8^＋、自然杀伤细胞（NK细胞），并计算CD4^＋／CD8^＋值。结果输血后1h两组APTT、PT、ACT均延长．FIB和血小板计数均降低（P〈0．05）但尚在正常范围内，两组间比较差异无显著性（P〉0．05）。与术前比较，异体输血组输血后第1天和第5天CD3^＋、CD4^＋、NK细胞数量显著减少（P〈0．01），回收式自体输血组上述指标无明显变化（P〉0．05）。结论回收式自体输血对凝血功能的影响与异体输血相似。回收式自体输血对机体细胞免疫功能无明显抑制作用。

Effect of autotransfusion on blood coagulation and immune function in patients undergoing orthopedic surgery

Objective] To investigate the changes in blood coagulation and T-Lymphocyte subset and natural killer cell after blood salvage and homologous blood transfusion.Methods] 40 patients undergoing elective orthopedic surgery were randomly divided into 2 groups:blood salvage group and homologous blood transfusion group.At preoperative,1 h and 24 h after blood transfusion,platelets,PT,APTT,FIB and ACT were measured.On 1st and 5th postoperation for determination of T-lymphocyte subsets and natural killer cell counts by flow cytometry and account CD4+/CD8+.Results] After blood transfusion,APTT,PT,ACT prolonged significantly,FIB and platelets decreased in these groups(P <0.05),There was no significant difference between the two groups.In homologous blood transfusion group,the number of CD3+,CD4+,CD4+/CD8+,NK cell was decreased obvious on 1st and 5th postoperation when compared with preoperation(P <0.01).But in the bood salvage group,the changes of CD3+,CD4+,CD4+/CD8+,NK cell were unsignificant.Conclusion] Intraoperative blood salvage and reinfusion does not induce significant change of blood coagulation as compared with allogenic blood trasfusion.The influence of blood salvage and retransfusion on immune function is slight.