同种输血对食管癌患者围手术期细胞因子的影响

目的　探讨同种输血对食管癌患者细胞因子生成的影响及相互关系。方法　食管癌患者手术常规输血18例 ,去白细胞输血 14例 ,采用生物素 亲和素系统测定技术检测患者围手术期常规输血和去白细胞输血后血清中IL 10、IFN γ和TNF α的浓度。结果　常规输血后第 1天与输血前相比血清中IL 10、IFN γ和TNF α浓度升高 ,且以IL 10、IFN γ变化尤为显著 ;输血后第 5天IFN γ和TNF α降低接近输血前水平 ,并明显低于去白细胞输血组 ,IL 10仍明显高于输血前水平。去白细胞输血后不同时间IL 10无显著性改变。结论　食管癌患者围手术期同种输血后血清中IFN γ和TNF α的降低与IL 10升高有关 ,而IL 10升高可能是患者同种输血后免疫抑制的最重要原因 ,输注去白细胞血液可减轻或去除这一作用。     

去白细胞输血在小儿心脏直视手术中的应用研究

目的　评价去白细胞输血在小儿心脏直视手术中减轻心肺组织损伤、降低术后感染率的效果。方法随机选取 344名择期在体外循环下行心脏直视手术的患儿 (术前无感染 ,心功能 >Ⅱ级 ) ,据术中输注血液成分的不同分为对照组 (未输血 ) 1 0 9人、常规输血组 (输注常规血液成分 ) 1 1 3人、去白输血组 (输注去白细胞血液成分 )1 2 2人 ,各组病例分别于术前、术后 6h、2 4h检测血清肌酸激酶同工酶 (CK MB)、门冬氨酸氨基转移酶 (AST)、乳酸脱氢酶 (LDH)、丙二醛 (MDA)水平 ,监测全肺阻力 (TPR)和呼吸指数 (RI)的变化 ,同时记录患者围手术期体温、外周血象变化及术后抗生素的使用天数。结果术后各组血清CK MB、AST、LDH、MDA水平较术前均明显提高 ,但各时向去白输血组血清 4项指标明显低于常规输血组 (P <0 .0 1或 0 .0 5 ) ;术中、术后去白输血组TPR和RI水平均低于常规输血组 (P <0 .0 1或 0 .0 5 ) ,与对照组比较无显著差异 (P >0 .0 5 ) ;去白输血组术后感染率及术后抗生素使用天数低于常规输血组 (P <0 .0 5 ) ,与对照组比较无明显差异 (P >0 .0 5 )。结论去白细胞输血在小儿心脏直视手术中可以有效地减轻心肺组织缺血再灌注损伤、降低术后感染率     

同种输血对食管癌患者体液免疫影响的实验研究

自从人们认识到同种输血具有输血介导的免疫调节作用后 ,关于癌肿手术患者同种输血与术后肿瘤复发率有关的临床研究报告陆续发表 [1,2 ] 。一般认为同种输血引起受血者免疫功能改变的主要原因与受血者免疫系统转向 Th2型有关。为了研究围手术期同种输血对食管癌患者体液免疫的影响 ,笔者检测了患者同种输血前后血清中免疫球蛋白和补体的水平 ,现报告如下。材料与方法1　临床资料　食管癌患者 34例 ,为本院行经胸食管癌根治手术患者 ,均经手术后病理确诊。年龄43～ 77岁 ,其中男性 2 7例 ,女性 7例。随机分为输注 40 0 ml全血和 2单位红细胞…     

围手术期去白细胞输血与术后切口感染的关系

目的探讨围手术期输注去白细胞输血与患者术后切口感染的关系。方法对2008年1月至2009年6月来自本院外科、妇科、口腔科病区的427例手术患者的病例资料进行围手术期输注去白细胞悬液与术后切口感染关系的回顾性调查分析。结果输注去白细胞悬液组切口感染率为13.1%,未输血组切口感染率为11.1%,2组差异无统计学意义(P0.05);但是随着去白细胞输血量增加,切口感染发生率逐渐增加,去白细胞悬液输血量为8～12 U组和12～16 U组同2～4 U组相比切口感染发生率明显增加,差异有统计学意义(P0.05)。结论围手术期患者术后感染发生率与输注去白细胞悬液之间无明显相关性,但大量输注去白细胞悬液可能会成为增加术后切口感染率的一个危险指标,对于去白细胞悬液临床医生应慎重、合理应用。     

异体输血对肝癌患者血浆IL-6、IL-10的水平的影响及预后情况的研究

目的探讨同种异体输血对肝癌根治术患者血浆白细胞介素-6(IL-6)、IL-10的水平的影响,为肝癌患者围术期及术后输注同种异体血后免疫功能的评估提供依据及相应的治疗方向。方法选择2013年12月至2017年6月在该院进行体检的100例体检健康者作为健康对照组,接受肝癌根治术患者250例,随机分为肝癌输去白细胞血组(n=100)和肝癌输全血组(n=150)。肝癌输去白细胞血组输注同种异体去白细胞血,肝癌输全血组输注同种异体全血。比较手术前(TA)、麻醉手术开始输血后2h(TB)、术后第1天早晨(TC)、术后第5天早晨(TD)4个时段,两肝癌组患者与健康对照组之间IL-6、IL-10的水平以及肝癌输去白细胞血组和肝癌输全血组之间IL-6、IL-10的水平。结果肝癌输全血组手术开始输血后2h及术后第1天IL-6、IL-10较肝癌输去白细胞血组稍低,差异有统计学意义(P0.05);肝癌输全血组术后第5天IL-6、IL-10较肝癌输去白细胞血组显著下降,差异有统计学意义(P0.05)。结论肝癌根治术后患者输注同种异体全血对患者免疫功能有一定的抑制作用,在肝癌根治术后输注同种异体全血患者血浆中IL-6、IL-10的定时检测,对监测患者病情,评估患者的免疫功能和患者手术预后的情况有一定的积极作用。     

不同输血方式对肺鳞癌患者围术期TNF-α和IL-10的影响

〖目的〗探讨同种输血和自体输血对肺鳞癌患者围术期肿瘤坏死因子-α(TNF-α)和白细胞介素-10(IL10)的影响和相互关系.〖方法〗2001年1月至2003年1月对31例肺鳞癌患者行肺癌根治术,将其分为两组,同种输血组(A组)17例,自体输血组14例(B组).测定两组围术期血清中TNF-α和IL-10的浓度.〖结果〗A组输血后d1与输血前相比血清中TNF-α、IL-1O浓度增高,以IL-10变化尤为明显,输血后d5TNF-α降低并接近输血前的水平,明显低于B组,IL-1O仍明显高于输血前的水平.B组中不同时间IL-10无显著变化,TNF-α于d5明显高于输血前.〖结论〗肺鳞癌患者围术期同种输血后血清中TNF-α降低与IL-10升高有关,IL-10升高可能是同种输血后免疫抑制的重要原因.自体输血可减轻或去除这一作用.     

原位肝移植围手术期成分输血相关问题的探讨

目的　探讨成人原位肝移植围手术期出凝血功能的变化及输血对手术预后的影响。方法　对肝移植术前肝功能Child分级均为C级 ,出凝血功能均存在异常的 19名患者通过补充凝血因子、血小板等成分进行纠正。无肝期采用体外静脉转流 ,术中动态监测血流动力学、出凝血功能变化及出血量 ,根据无肝前期、无肝期、新肝期各项出凝血功能指标的变化 ,给予相应的输血处理 ,分别以术后生存情况和围手术期输血量分组 ,分析各种输血因素对移植术中、术后的影响。结果　在术前肝功能分级、出凝血功能、手术方式、方法、时间无明显差异的情况下 ,输血总量、红细胞用量、冰冻血浆用量与术后存活率呈明显负相关 ,偏相关系数分别为 - 0 .75 18(P <0 .0 1)、- 0 .710 4 (P<0 .0 1)、- 0 .5 14 4 (P <0 .0 5 )。死亡组输血量明显高于存活组 ,差异显著 (P <0 .0 5 ) ;输血量≥ 10 0 0 0ml组死亡率明显高于输血量 <10 0 0 0ml组 ,差异显著 (P <0 .0 5 ) ;所有病例中无一发生输血后巨细胞病毒 (CMV)感染、颅内出血。结论　术前充分纠正出凝血功能异常 ,术中进行动态监测 ,及时通过各种血液成分在品种和剂量上的合理输注进行调控及应用去白细胞输血等新技术 ,可保证原位肝移植手术顺利进行 ,有效降低输血总量 ,减少术后并发症。     

不同输血方式对肺鳞癌患者围术期TNF—α和IL—lO的影响

[目的]探讨同种输血和自体输血对肺鳞癌患者围术期肿瘤坏死因子-α(TNF-α)和白细胞介素—10(IL—10)的影响和相互关系。[方法]2001年1月至2003年1月对31例肺鳞癌患者行肺癌根治术，将其分为两组，同种输血组(A组)17例，自体输血组14例(B组)。测定两组围术期血清中TNF-α和IL—10的浓度。[结果]A组输血后d1与输血前相比血清中TNF-α、IL-10浓度增高，以IL—10变化尤为明显，输血后d5TNF-α降低并接近输血前的水平，明显低于B组，IL—10仍明显高于输血前的水平。B组中不同时问IL—10无显著变化，TNF-α于ds明显高于输血前。[结论]肺鳞癌患者围术期同种输血后血清中TNF-α降低与IL—10升高有关，IL—10升高可能是同种输血后免疫抑制的重要原因。自体输血可减轻或去除这一作用。     

输血对脑外伤患者术后感染的影响

目的 探讨输血对脑外伤患者术后感染的影响,指导合理输血。方法 选择本院1997年1月~2004年1月525例脑外伤手术患者,其中225例术中输注普通悬浮红细胞,202例输注悬浮去白细胞红细胞,98例未输血。对3组患者术后感染率及输血剂量与感染率的关系进行比较。结果 普通悬浮红细胞输血组术后感染率为11．11％,悬浮去白细胞红细胞输血组术后感染率为3．46％,与普通悬浮红细胞输血组相比差异有显著性（P〈0．01）,与未输血组感染率（2．04％）比较差异无显著性。普通悬浮红细胞输血组患者的输血量与术后感染的发生显著相关（P〈0．01）,而悬浮去白细胞红细胞输血组的输血量与术后感染率的相关性不显著。结论 脑外伤患者术后感染的发生与输血、血液成分及输血量等有关。在保证患者能够耐受手术的情况下,应尽量不输血或少输血,对确需输血的患者,应该输注去白细胞红细胞。     

等容血液稀释自体输血对围手术期患者电解质的影响

【目的】研究等容血液稀释自体输血对围手术期患者体内电解质水平的影响。【方法】本院2009年12月至2011年12月手术患者700名,随机分为异体输血组（AL组）和等容血液稀释自体输血组（AU组）各350名。AL组输注异体全血600800mL;AU组术前经桡动脉取自体血400mL,术中经静脉输入羟乙基淀粉400mL,手术后半阶段将自体血回输给患者。所有患者均于手术当日清晨空腹（术晨）、（异体或自体）输血前、术后d,和术后d3清晨抽肘静脉血2mL,检测静脉血中Na＋、K＋、C1-和Ca2＋水平。【方法】两组患者Na＋、K＋、C1-和Ca2＋水平术晨和输血前比较无显著性差异;AL组患者术后d1K＋水平显著降低（P〈0．05）,Na＋、C1-水平显著增加（P〈0．01）,而Ca2＋水平无显著性差异（P〉0．05）,术后d3均回复正常;AU组患者术后Na＋、K＋、C1-、Ca2＋水平与术晨和输血前相比均无显著性变化（P〉0．05）。术后d1,AL组的K＋水平明显低于AU组（P〈0．01）、Na＋、C1-水平AL组明显高于AU组（P〈0．01）,但Ca2＋水平比较无显著性差异（P〉0．05）;术后d3,电解质水平两组比较均无显著性差异（P〉0．05）。【结论】采用稀释式自体输血对外科患者围手术期电解质水平的影响较小,有助于维持患者内环境的稳定。     

输血对脑膜瘤术后感染的影响

目的 观察输血对脑膜瘤病人术后感染的影响。方法 对1998年1月～1999年1月本院257例脑膜瘤病人的术中输血进行临床观察,其中132例患输异体血,125例输自体血,比较两组病例术后感染率。结果 自体输血组病人术后感染率为0．08%;异体输血组病人术后感染率为4．55％。结论 异体输血会增加脑膜瘤病人术后感染率。     

输血对脑膜瘤患者术后感染的影响观察

目的　了解输血对脑膜瘤患者术后感染的影响。方法　选择本院 2 5 7名脑膜瘤术中输血的患者进行临床观察 ,其中 132例输异体悬浮红细胞 ,12 5例输自体血 ,对两组病例术后感染率进行比较。结果　发现自体输血组患者术后感染率为 0 0 8% ,异体输血组患者术后感染率为 4 5 5 % ,两组术后感染率有显著性差异。结论　脑膜瘤患者术中异体输血者较自体输血者术后感染率高 ,其术后感染率与输异体血的量密切相关。     

The effects of leukoreduced blood transfusion on infection risk following injury: a randomized controlled trial

Allogeneic blood transfusions in surgical patients have been associated with an increased risk of infectious complications and organ dysfunction. Residual leukocytes contaminating units of packed red blood cells have been incriminated through the induction of anergy and/or a potentiated inflammatory response, leading to the possibility that leukoreduced red blood cell transfusion might mitigate these effects. We set out to evaluate the effect of leukoreduced red cell transfusion on the risk of infections complications in patients requiring transfusion following injury. We conducted a single-center, double-blinded randomized controlled trial of leukoreduced versus standard, nonleukoreduced red blood cell transfusions in injured patients receiving transfusion within 24 hrs of injury. The primary endpoint was infectious complications within 28 days of randomization. Secondary end points were multiple organ failure, length of stay, febrile episodes, and mortality. Two hundred sixty eight subjects were eligible for analysis. Rates of infectious complications were similar in subjects receiving leukoreduced transfusions (30%) or standard transfusions (36%) ([RR], 0.84 [0.55-1.3]) and there was no statistically significant effect of leukoreduced blood transfusion on mortality [RR, 1.20 (0.74-1.9)], febrile episodes [RR, 1.01 (0.89-1.2)], or organ dysfunction scores (5.9 vs. 6.6; P=0.29). Thus, pre-storage leukoreduction of allogeneic red blood cells had a small, but non-significant effect on the rate of infectious complication in this high-risk population requiring transfusion. There was no effect on the rates of febrile episodes, mortality, length of stay, or severity of organ dysfunction.     

Blood transfusion and septic complications after hip replacement surgery

BACKGROUND: The purpose of this study was to address some methodologic issues that might help explain the disagreement between the findings of earlier reports on the presumed association between allogeneic blood transfusion and the increased postoperative infection rates seen in orthopedic surgery patients. STUDY DESIGN AND METHODS: A retrospective review of the incidence of postoperative septic complications in 367 patients from Olmsted County, Minnesota, who underwent 420 elective total hip arthroplasties between 1986 and 1993, was conducted. The infection rates in the exposed patients (those who had perioperatively received allogeneic blood components only or allogeneic and autologous blood components) were compared with those in the untransfused patients and patients who received only autologous blood. The study had sufficient statistical power to detect a deleterious effect of allogeneic blood transfusion equal to the 2.8-fold effect observed in a recent randomized clinical trial of patients undergoing elective abdominal surgery. RESULTS: There was no association of allogeneic blood transfusion with postoperative infection (p = 0.226). Nineteen infections occurred in 201 exposed patients (9.5%), as compared to 14 infections in 219 unexposed patients (6.4%). CONCLUSION: Allogeneic blood transfusion does not increase the incidence of post-operative septic complications in patients undergoing elective total hip arthroplasty, at least to the extent that the statistical power of this study allowed the determination.     

Mannose-binding lectin is involved in multiple organ dysfunction syndrome after cardiac surgery: effects of blood transfusions

BACKGROUND: Serum levels of mannose-binding lectin (MBL), a recognition molecule of the lectin pathway of complement, are highly variable, based on genetic variation. After cardiac surgery, extracorporeal circulation and ischemia-reperfusion injury initiate a systemic inflammatory response, which can evolve to multiple organ dysfunction syndrome (MODS). Preoperative transfusions of allogeneic white blood cells (WBCs) contribute to infectious and inflammatory complications. This study investigates the role of MBL in relation to blood transfusions and complications after cardiac surgery. STUDY DESIGN AND METHODS: In cardiac surgery patients who participated in a randomized trial comparing leukoreduced with buffy coat-depleted red blood cell (RBC) transfusions, circulating MBL was measured pre- and postoperatively by enzyme-linked immunosorbent assay (ELISA). Data were related to the incidence of complications and to the transfusions the patients received. RESULTS: Patients with high preoperative serum MBL levels (>400 ng/mL) show a significant (52 +/- 12%) decrease of serum MBL postoperatively, whereas patients with low serum MBL levels (< or =400 ng/mL) show a significant increase of serum MBL levels after surgery (140 +/- 106%), which was further enhanced by fresh-frozen plasma (FFP) transfusions. MBL levels were not associated with infections, sepsis, or death. Patients with MBL deficiency (MBL < or = 80 ng/mL) were protected against development of MODS (p = 0.016), whereas FFP transfusion abolished this protection (p = 0.048). CONCLUSION: Cardiac surgery is associated with MBL consumption, independent of the transfusion of allogeneic WBCs. Patients with MBL deficiency develop no MODS, unless they have been transfused with FFP, which is associated with MBL reconstitution. Therefore, sustained MBL deficiency may be a favorable status for patients undergoing cardiac surgery.     

Transmission of cytomegalovirus (CMV) infection by leukoreduced blood products not tested for CMV antibodies: a single-center prospective study in high-risk patients undergoing allogeneic hematopoietic stem cell transplantation (CME)

BACKGROUND: Measures to prevent transfusion‐transmitted cytomegalovirus (TT‐CMV) infection after hematopoietic stem cell transplantation (HSCT) include transfusion of CMV antibody–negative blood units and/or transfusion of leukoreduced cellular blood products. We assessed the incidence of TT‐CMV in CMV‐seronegative patients receiving CMV‐seronegative HSC transplants, who were transfused with leukoreduced cellular blood products not tested for anti‐CMV. STUDY DESIGN AND METHODS: In a prospective observational study between 1999 and 2009, all HSCT patients received leukoreduced cellular blood products not tested for anti‐CMV. Patients were screened for CMV serostatus and CMV‐negative recipients of CMV‐negative transplants were systematically monitored for TT‐CMV clinically and by CMV nucleic acid testing. Anti‐CMV antibodies (immunoglobulin [Ig]G and IgM) were assessed after three time intervals (Interval 1, study inclusion to Day +30 after HSCT; Interval 2, Day +30‐Day +100; Interval 3, after Day +100). RESULTS: Among 142 patients treated with allogeneic HSCT, 23 CMV‐negative donor‐patient pairs were identified. These 23 patients received 1847 blood products from 3180 donors. All patients remained negative for CMV DNA and none developed CMV‐associated clinical complications. This results in a risk for TT‐CMV per donor exposure of 0% (95% confidence interval, 0.0%‐0.12%). However, 17 of 23 patients seroconverted for anti‐CMV IgG, but none for anti‐CMV IgM. CMV IgG seroconverters received significantly more transfusions per week than nonconverters. CONCLUSION: The risk of TT‐CMV is low in high‐risk CMV^neg/neg HSCT patients transfused with leukoreduced blood products not tested for anti‐CMV. The cause of anti‐CMV IgG seroconversion is most likely passive antibody transmission by blood products.     

Transfusion of buffy coat-depleted blood components and risk of postoperative infection in orthopedic patients

BACKGROUND: Allogeneic blood transfusions have been reported to increase susceptibility to postoperative infection, but the findings were inconclusive. This study was designed to investigate the effect of buffy coat-depleted allogeneic and autologous transfusion on postoperative infection in patients undergoing orthopedic surgery. STUDY DESIGN AND METHODS: Patients (n = 385) undergoing elective orthopedic surgery (primary and revision joint replacement, spinal, or pelvic surgery) were included in a prospective observational study of the incidence of postoperative infection between April and December 1996. Infection rates in patients who received allogeneic buffy coat-depleted blood transfusions were compared with those in patients who received no transfusion or only autologous (buffy coat-depleted) blood. RESULTS: Patients without exposure to allogeneic blood (no blood or only autologous blood) had an infection rate of 3.9 percent, as compared to a rate of 12.2 percent for those with exposure to allogeneic blood (allogeneic blood, autologous plus allogeneic blood) (odds ratio 3.442; 95% CI, 1.349-10.40; p = 0.006). Of the 385 study patients, 309 underwent primary hip or knee replacement surgery. In this homogeneous subgroup, the postoperative infection rate was 4.6 percent after no transfusion or autologous transfusion and 11.9 percent after allogeneic transfusion (odds ratio 2.827; 95% CI 1.059-8.799; p = 0.036). Multivariate regression analysis confirmed buffy coat-depleted allogeneic blood transfusion as an independent variable associated with high risk for postoperative infection. CONCLUSION: Buffy coat-depleted allogeneic blood transfusion increases the incidence of postoperative infection in patients undergoing uncontaminated orthopedic surgery.     

输血对食管癌手术患者免疫功能的影响

目的探讨输血对食管癌手术患者免疫功能的影响。方法140例食管癌患者，随机分为手术中输血组（64例）和未输血组（76例），分别于手术前第1天及手术后第3、14天采取静脉血，采用EHSA法测定患者血清中CD4、CD8的含量；采用郭峰法测定血液中红细胞C3b受体花环率（RBC-C3bRR）、红细胞免疫复合物花环率（RBC-ICR）、肿瘤细胞花环率（TRR）水平。结果与正常人相比，食管癌患者手术中输血组与未输血组相比血清中CD4水平降低，CD8水平升高，CD4／CD8比值降低（P〈0．01）；输血组RBC-ICR较未输血组升高，RBC-C3bRR和TRR均较未输血组降低（P〈0．01）。结论手术中输血可使食管癌患者手术后淋巴细胞和红细胞免疫功能减低。     

Use of recombinant human erythropoietin to assist autologous blood donation by anemic rheumatoid arthritis patients undergoing major orthopedic surgery

BACKGROUND: In rheumatoid arthritis (RA) patients undergoing orthopedic surgery, anemia is the major factor in the use of allogeneic blood. STUDY DESIGN AND METHODS: To determine whether recombinant human erythropoietin (rHuEPO) could allow preoperative autologous blood procurement and reduce allogeneic blood exposure, 11 RA patients who were unable preoperatively to deposit blood for autologous use because of their anemia (baseline hematocrit < 34% [0.34]) and who were scheduled for primary total hip replacement or total knee replacement were treated intravenously with 300 U per kg of rHuEPO in combination with intravenous iron saccharate (100 mg), given twice weekly for 3 weeks. The transfusion treatment was compared with that in 12 control patients with comparable baseline hematologic values who underwent the same operation. RESULTS: Control patients could not preoperatively deposit any blood for autologous use, while all but one of the rHuEPO- treated patients deposited 2 or more units (mean, 2.6 +/− 0.6; range, 2- 4) (p < 0.001). The control group received more allogeneic units (2.6 +/− 1.6 vs. 0.8 +/− 0.8) (p = 0.009). Moreover, 50 percent of the rHuEPO-treated patients, as compared with 8 percent of controls, completely avoided allogeneic transfusion. CONCLUSION: Recombinant human erythropoietin is safe and effective in stimulating erythropoiesis, allowing preoperative donation of blood for autologous use, and reducing exposure to allogeneic blood for RA patients who are unable preoperatively to deposit blood because of anemia.