异体和自体输血对手术病人免疫功能的影响

本文就异体输血和自体输血对免疫功能的影响的最新观点作一综述,以促进自体输血在手术中的应用。     

异体和自体输血对手术病人免疫功能的影响

本文就异体输血和自体输血对免疫功能的影响的最新观点作一综述,以促进自体输血在手术中的应用。     

贮存式自体输血对急性失血性休克兔骨髓造血细胞的影响

目的探讨贮存式自体输血(PABD)对急性失血性休克新西兰家兔骨髓造血细胞的影响。方法雄性新西兰家兔24只,体重1.9~2.4kg,采用随机数字表法分为四组:对照组(CON组)、异体输血组(ABT组)、自体采血组(ABS组)及贮存式自体输血组(PAT组),每组6只。ABS组和PAT组模拟休克前进行3次自体血采集贮存,每次间隔1周,至休克前72h完成。CON组和ABS组进行股动脉分离不模拟休克,ABT组和PAT组兔急性失血性休克模型建立后,ABT组输入ABS组贮存的血液进行复苏,PAT组输入术前贮存的自体血液进行复苏。在血液贮存前(T1)、血液贮存后(T2)、休克前(T3)、复苏后即刻(T4)及复苏后24h(T5)测定四组家兔外周血的Hb、网织红细胞(RET)比例,复苏后24h抽取兔骨髓测定有核细胞计数和骨髓细胞静止期/合成前期(G0/G1)、合成期(S)、合成后期/分裂期(G2/M)各期所占比例。结果 T2~T5时ABS组,T2、T3时PAT组,T4时ABT组Hb浓度明显低于CON组(P0.05)。T2~T5时ABS组和PAT组RET比例明显高于CON组和ABT组(P0.05)。T5时ABS组和PAT组骨髓有核细胞计数分别为[(6.30±1.75)×107/ml]、[(5.64±2.42)×107/ml],明显高于CON组的[(3.16±1.09)×107/ml]和ABT组的[(2.28±0.92)×107/ml](P0.05)。ABS组和PAT组骨髓细胞G0/G1期比例明显低于CON组和ABT组,S期比例明显高于CON组和ABT组,G2/M期比例明显高于ABT组(P0.05);ABT组骨髓细胞G0/G1期比例明显高于CON组,S期和G2/M期比例明显低于CON组(P0.05)。结论贮存式自体输血能够通过刺激骨髓造血细胞由静止期进入增殖分裂期,增加网织红细胞比例,促进术后血红蛋白的早期恢复。     

贮存式自体全血与单纯红细胞输注对家兔骨髓造血干细胞功能的影响

目的 探讨贮存式自体全血和红细胞成分对骨髓造血干细胞衰老相关指标的影响.方法 健康雄性新西兰家兔30只,3～6月龄,体重2.5～3.0 kg.采用随机数表法将其分为五组:对照组(C组)、单纯手术组(S组)、手术采血组(ABS组)、贮存式自体全血输注组(PAB组)和贮存式自体红细胞输注组(PARB)组,每组6只.C组家兔...     

不同贮存时间对自体输血红细胞携氧能力及氧化损伤的影响

目的:探究贮存式自体输血（preoperative autologous blood donation, PABD）适宜贮血时间,为保障自体血应用的安全性及有效性提供理论依据。方法:选取具有PABD适应证的骨科手术患者10例,根据体重计算总血容量,术前1周采集10%总血容量的自体血,于采血前、采血毕检测患者血常规及血流...     

回收式自体输血对脊柱外科围手术期出凝血与血携氧功能的影响

目的：观察回收式自体输入血（ATS）在脊柱外科手术中的应用及其对围手术期几项血液指标的影响。方法：将62例脊柱损伤患者，按手术种类分为5组，分别测定术前、术后1d、术后7d血液中Hb、HCT、PaO2、Fbg、PLT、PT，比较各组ATS量的变化及其对出凝血状况和血携氧功能的影响。结果：回输自体血量52860ml，占总输血量的80．26％。术后Hb、HCT、PLT均不同程度减少，PT显著延长（P＜0．01），Fbg无明显变化，PaO2显著升高（P＜0．01）。结论：围手术期虽有轻度贫血但不影响血携氧功能，术后PT显著延长却未出现出凝血功能障碍，ATS技术能明显减少异体血用量，可安全应用于脊柱外科手术。     

异体与术中回收式自体输血对凝血功能影响的比较

目的 观察术中回收式自体输血后凝血状态的变化。方法36例择期行骨科大手术病人,将同性别,手术类型及年龄相近的两位病人配为一对,随机分配到回收式自体输血组(试验组)或异体输血组(对照组)中。试验组用血液回收仪回收术中出血,经过滤、离心、清洗后回输给病人。分别取术前、输血前、输血后1h及术后24h的静脉血,测定血常规、凝血酶原时间(PT)、部分凝血酶原时间(APTT)、纤维蛋白原(FIB)、凝血酶时间(TT),同时用血栓弹性描记仪测定血栓弹性描记图(Thrombelastography,TEG)的各项指标。结果 试验组稀释后Hb明显低于对照组(P<0.05)。血常规其余各值、PT、APTT、FIB及TT在各测定点两组变化一致,两组间均无显著差异(P>0.05);试验组R在稀释后明显延长(P<0.05),但与对照组比差异不显著。两组间TEG其它各项指标在各测定点亦差异不显著(P>0.05)。结论 回收式自体输血与异体输血相比对凝血状态的影响差异不显著。     

贮存式白体输血在白血病治疗中的临床应用

目的：探讨贮存式自体输血对白血病治疗的可行性。方法40例白血病缓解患者分为贮存式自体输血20例和异体输血20例。贮存式自体输血方式：患者在化疗前3天，采集自体全血200-400ml，于4℃保存，待患者病情需要时回输。结果自体输血组患者异体输血量远远低于无自体输血组患者，自体输血组患者未出现发热反应和过敏反应等输血不良反应，无自体输血组患者出现2例发热反应，3例过敏反应，P〈O．001，有显著统计学意义。结论贮存式自体输血可减少异体输血量及输血不良反应，对白血病治疗是科学、经济、有效的输血方式。”     

Predictors of allogenic blood transfusion in elective cardiac surgery after preoperative autologous blood donation

Purpose  Preoperative autologous blood donation (PAD) is important for reducing exposure to allogenic blood in cardiac surgery. Unfortunately, even after PAD, allogenic blood transfusion is not always avoided. We investigated the predictors of blood component usage during elective cardiac surgery in patients prepared with PAD. Methods  Clinical data were collected for 143 consecutive patients (103 men and 40 women; mean age, 62 ± 9 years) who underwent elective cardiac surgery after PAD (959 ± 240 ml), often using iron supplement and recombinant human erythropoietin. Results  Allogenic blood transfusion was avoided during and after surgery in 107 patients (75%), whereas 36 patients required an allogenic transfusion (4.1 ± 3.8 U of packed red cells, 3.4 ± 4.1 U of fresh frozen plasma, and 5.8 ± 11.0 U of platelet concentrate). The independent factors for perioperative allogenic blood transfusion in these patients included the pre-donation hemoglobin value, the preoperative platelet count, and the lowest hemoglobin value during cardiopulmonary bypass. Conclusion  Even with PAD for elective cardiac surgery, patients whose pre-donation hemoglobin value and preoperative platelet count are low may require allogenic blood transfusion.     

The current role of preoperative and intraoperative autologous blood donation in pediatric open-heart surgery

Objective: We assessed the current role of preoperative and intraoperative autologous blood donation in pediatric open-heart surgery. Methods: Group 1 consisted of 51 patients between 5 and 10 years old who underwent preoperative autologous blood donation. Group 2 consisted of 50 age-matched patients without preoperative donation as controls. Intraoperative donation was conducted in both groups prior to cardiopulmonary bypass. We evaluated perioperative blood cell count, blood loss, and the need for homologous blood products. Results: No serious complications occurred in preoperative or intraoperative donation. Total preoperative donation storage was 17.5±3.4 mL/kg. Intraoperative donation was 21.7 ±6.1 mL/kg in Group 1 and 12.8±4.0 mL/kg in Group 2 (p<0.001). On admission, serum hemoglobin was lower in Group 1 (12.2±1.0 g/dL versus 13.6±1.6 g/dL, p<0.001) but returned postoperatively to the preoperative value. It hovered at a depressed level in Group 2 (12.2±1.4 versus 10.2±1.1 g/dL, p<0.001). The homologous blood requirement was significantly less in Group 1 than in Group 2 (0% versus 10%, p<0.05). Postoperative platelet counts showed similar curves, and blood loss was not statistically significantly different between groups. Conclusion: Preoperative and intraoperative donations are safe and continue to contribute uniquely to blood conservation, providing important options in comprehensive blood conservation programs in current pediatric open-heart surgery.     

Efficacy of preoperative donation of autologous blood in patients undergoing radical retropubic prostatectomy

BACKGROUND: Radical retropubic prostatectomy (RRP) has resulted in substantial blood loss and the frequent need for homologous blood transfusion. In this study, the efficacy of autologous blood transfusion, from medical and financial perspectives, was evaluated in patients undergoing RRP. METHODS: Between 1994 and 2000, 80 patients with localized prostate cancer underwent RRP in our institute. Based on informed consent, preoperative donation of autologous blood (PDA) was performed in 65 out of 80 patienets. Four or six units were donated during the first 3 years; however, donation units were reduced to a maximum of 4 units since 1997 onwards. The discard rate of donated blood and frequency of homologous transfusion were examined. Changes of hematocrit (Ht) and hemoglobin (Hb) levels through donation and surgery and important factors that may affect postoperative levels of Ht and Hb were evaluated in 56 patients receiving 4-unit donations. RESULTS: Overall, 2 or 4 units of donated blood were discarded in four patients and homologous transfusion was required in two patients. In 56 patients receiving 4-unit donation, the mean Ht level at predonation was 43.3%. Following donation, this decreased to 35.7%. The administration of recombinant human erythropoietin (rHuEpo) relieved declining Ht levels following donation, but changes in Ht levels after surgery were minor. Important factors related to postoperative decline of Ht and Hb levels were operative time and blood loss. CONCLUSIONS: The program of 4-unit PDA can be performed safely without rHuEpo injection, and it is useful to reduce the risk of requiring homologous transfusion. However, more efficient programs to relieve patient burden and to reduce medical cost are needed.     

川芎嗪对自体血回输患者围术期体液免疫功能的影响

目的 探讨川芎嗪对自体血回输患者围术期体液免疫功能的影响.方法 择期行脊柱手术患者60例,年龄20～60岁,体重50 ～ 75 kg,ASA分级Ⅰ或Ⅱ级,采用随机数字表法,将患者随机分成2组(n=30),试验组:于收集自体血前30 min,经5 min静脉输注川芎嗪2mg/kg,并在回收血液的肝素盐水和洗涤盐水内加入川芎嗪,每500 ml加入川芎嗪25 mg;对照组不给予川芎嗪.于麻醉诱导前(T0)、术后1 h(T1)、1 d(T2)及5 d(T3)时取静脉血样,采用ELISA法测定血清免疫球蛋白(IgG、IgM)的浓度;记录手术时间、术中出血量、回输血量.结果 两组患者手术时间、术中出血量、回输血量比较差异无统计学意义(P＞ 0.05).与T0时比较,对照组T1～T3时血清IgG和IgM浓度降低,试验组T1、T2时血清IgG浓度降低(P＜0.05或0.01),T3时差异无统计学意义,T1～T3时血清IgM浓度差异无统计学意义(P＞0.05);与对照组比较,试验组T2、T3时血清IgG浓度、T1～T3时血清IgM浓度升高(P ＜0.05或0.01).结论 川芎嗪可在一定程度上减轻自体血回输患者体液免疫抑制,改善体液免疫平衡状态.     

自体血回输对青少年特发性脊柱侧凸患者围手术期细胞免疫功能的影响

目的：探讨自体血回输对青少年特发性脊柱侧凸患者围手术期细胞免疫功能的影响。方法：2002年2月～2005年2月，根据术中输血的方式将特发性脊柱侧凸患者148例分为2组，异体输血组(Ⅰ组)42例：术中全部输异体成分血；自体血回输组(Ⅱ组)106例：术中采用血液回收机将自体血回输给患者，使患者红细胞比容(HCT)≥30％，Hb≥10g／L，如果达不到低限，适量补充异体血。观察两组异体血输入量、过敏反应发生率；并分别于入手术室、术后第1天及第5天抽取静脉血，测定T细胞亚群和NK细胞的数量。结果：Ⅰ组平均异体血输入量850±170ml，Ⅱ组中有58例除了自体血回输外补充了异体血，平均410±150ml。输血反应发生率Ⅰ组为26．2％(11／42)，Ⅱ组为4．7％(5／106)，两组间存在显著性差异(P＜0．01)。两组术后第1天CD3~+、CD4~+、CD4~+／CD8~+、NK细胞较术前显著减少(P＜0．05或P＜0．01)，异体输血组较自体输血组减少更明显(P＜0．05)。术后第5天异体输血组CD3~+、CD4~+、CD4~+／CD8~+、NK细胞仍较术前显著减少，自体输血组基本恢复正常，两组间存在显著差异(P＜0．05)。结论：自体血回输可明显减少脊柱侧凸矫形患者异体血输入量，术后自体输血患者细胞免疫功能的抑制较异体血输入者轻，术后细胞免疫功能恢复快。     

输血对食管癌病人免疫功能的影响

目的　探讨输血对食管癌病人免疫功能的影响。方法　95例食管癌病人围术期输血者49例、未输血者46例,于术前、术后1、3、7、14?d分别检查细胞及体液免疫指标--外周血T淋巴细胞及其亚群和血浆TNF、红细胞C     

Mannheim concept of preoperative autologous blood donation and perioperative autologous blood transfusion in hip endoprosthesis surgery

PURPOSE: To investigate the efficiency of preoperative autologous deposit and intra- and postoperative cell salvage (CS) to reduce homologous transfusion in hip arthroplasty and revision hip arthroplasty. METHODS: In a retrospective study, the data of 1402 patients scheduled for hip arthroplasty and for revision hip arthroplasty were analysed. RESULTS: 767 women and 635 men, age 62.9 +/- 9.8 years (x +/- s) were included in the study. 1270 were scheduled for hip arthroplasty, 132 for revision hip arthroplasty. Of the autologous donors, 51 patients predeposited four units, 1020 patients three, 204 patients two, 39 patients one unit. 88 patients who had not enrolled in the autologous donation program but received CS served as a control group. Blood loss in autologous donors amounted to 1620 (220-5620) ml in hip arthroplasty and 2830 (950-7910) ml in revision arthroplasty. CS was employed in part of the cases in arthroplasty and in all revision operations. 470 (0-2200) ml and 705 (0-2200) were retransfused. In hip arthroplasty 227 of 1182 patients (19.2%) received homologous blood. Homologous transfusion in patients with coxarthrosis due to acetabular protrusio, avascular necrosis of the femoral head and hip dysplasia showed a trend to higher values. Patients who had donated 3 units and received CS required homologous transfusion in 12.4% of the cases. CS reduced the homolgous transfusion rate significantly if the preoperative hemoglobin concentration was < or = 12 g/dl. A group of autologous donors receiving CS was matched with patients receiving CS only. 12 of 76 (15.8%) vs. 45 of 76 (59.2%) required homologous transfusion. In revision hip arthroplasty 58 of 132 patients (43.9%) required homologous blood. CONCLUSIONS: Preoperative deposit reduces homologous transfusion requirements considerably in hip surgery. Under the conditions studied CS should be employed in hip arthroplasty in addition to preoperative deposit if the preoperative hemoglobin concentration falls below 12 g/dl. In revision arthroplasty, 4 or more autologous units should be predeposited and CS should be used regularly.     

Targeted pre-operative autologous blood donation: a prospective study of two thousand and three hundred and fifty total hip arthroplasties

Purpose

Pre-operative donation of autologous blood has been widely used in elective joint replacement procedures to avoid the risks of allogeneic blood transfusions. However, the high percentage of wasted autologous blood questions the general efficacy of pre-operative autologous blood donation (PABD) for all patients undergoing hip replacement. This study prospectively investigates the impact of a targeted pre-operative autologous blood donation protocol for anaemic patients on allogeneic and overall transfusion rates in 2,350 unilateral primary total hip arthroplasty procedures.

Methods

Patients with pre-operative haemoglobin less than 12.5 g/dL were advised to donate one unit of autologous blood seven to 15 days prior to the date of surgery. The targeted protocol was followed by 2,251 patients: 280 out of 367 anaemic patients donated while 1,971 out of 1,983 non-anaemic patients did not donate.

Results

Results showed a significantly lower rate of allogeneic transfusion for anaemic patients who predonated than anaemic patients who did not (13 % vs. 37 % respectively, p < 0.001). Overall transfusion rates for patients who followed the protocol (n = 2,251) were found to be 0.17 units/patient compared to previously reported numbers of 0.75 units/patient when routine donation was used. Among the 2,251 patients who followed the protocol, only 140 patients (6 %) had their autologous blood wasted, in contrast to values reported in the literature ranging from 14 % up to 50 %.

Conclusions

Targeted PABD reduces the need for allogeneic blood transfusion in anaemic patients and significantly reduces the overall number of transfusions compared to routine pre-operative autologous donation.