回收式自体输血对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（BS）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患者40例，随机分为自体输血组（BS组）和异体输血组（异体组）各20例，术中分别采用BS及输异体血，分别于术前、输血后1h及输血后24h测定血常规、APTT、PT、FIB及ACT；流式细胞仪测定输血后第1天、第5天T淋巴细胞亚群CD3^＋、CD4^＋、CD8^＋、CD4^＋／CD8^＋值及NK细胞。结果输血后1h两组APTT、PT、ACT均延长，FIB和PLT计数均降低（P〈0．05），但尚在正常范围内，组间比较元显著性差异（P〉0．05）。异体输血组输血后第1天和第5天CD3^＋、CD4^＋、CD8^＋、NK变化显著低于BS组（P〈0．01）；BS前后上述指标元明显变化（P〉0．05）。结论．BS对凝血功能的影响与异体输血相似，大量回输时应注意补充凝血因子和血小板；BS对机体细胞免疫功能元明显抑制作用。

Changes in blood coagulation and T-Lymphocyte subset and natural killer cell after blood salvage and homologous blood transfusion

[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 erthopextic surgery were randomly divided into 2 groups: blood salvage group and homologous blood transfusion group.On preoperative,1 h after blood transfusion and 24 h after blood transfusion,PLT,PT,APTT,FIB and ACT were measured.On the 1st and 5th day after operation measured T-lymphocyte subsets and natural killer cell counts by flow cytometry and account CD~+_4/CD~+_8. [Results] After blood transfusion,APTT,PT,ACT increased significantly,and FIB and PLT decreased in these groups(P<0.05),there was no significant difference between the two groups.In The homologous blood transfusion group the number of CD~+_3,CD~+_4,CD~+_4/CD~+_8,NK cell decreased obviously on the 1st and 5th day after operation compared with preoperative(P<0.01), there were no signifrcant changes in the bood salvage group.[Conclusion] Intraoperative blood salvage and reinfusion induce no significant effects on blood coagulation as compared with allogenic blood transfusion.Blood salvage influence on immune function is slight.