术中自体血液回收对红细胞流变学的影响

目的通过检测术中自体回收血液的流变学指标,评价血液回收技术对红细胞流变学的影响。方法前瞻性自身对照研究,观察20例2018年1~12月于首都医科大学附属北京友谊医院择期行非停跳冠脉动脉旁路移植手术、拟使用术中自体血液回收机对术野血液进行回收的患者。采用椎板法对患者静脉血、术中自体回收血液和同期10份使用枸橼酸-磷酸-葡萄糖-腺苷保护液贮存10~15 d的悬浮红细胞进行聚集指数,变形指数和全血黏度检测。结果自体回收红细胞的聚集指数和变形指数分别为4. 37±0. 83和0. 84±0. 22,静脉血红细胞分别为4. 55±0. 83和1. 01±0. 25,两者相比较差异均无统计学意义(P=0. 413,0. 051);自体回收红细胞的切变率200/s、切变率30/s、切变率5/s和切变率1/s时的全血黏度分别为3. 40±0. 54 m Pa·s、4. 36±0. 84 m Pa·s、7. 12±1. 85 m Pa·s和15. 10±5. 15m Pa·s,静脉血红细胞分别为3. 15±0. 90 m Pa·s、4. 05±1. 18 m Pa·s、6. 67±2. 06 m Pa·s和14. 25±4. 80 m Pa·s,两者相比差异均无统计学意义(P=0. 234,0. 310,0. 428,0. 543)。贮存10~15 d的悬浮红细胞的聚集指数和变形指数分别为4. 55±1. 41和0. 91±0. 30,与静脉血红细胞相比差异无统计学意义(P=0. 892,0. 863);悬浮红细胞在切变率5/s和切变率1/s时全血黏度分别为6. 45±1. 29 m Pa·s和13. 79±3. 35 m Pa·s,与静脉血红细胞相比差异均无统计学意义(P=0. 103,0. 203);悬浮红细胞在切变率200/s、切变率30/s时的全血黏度分别为3. 08±0. 58 mPa·s和3. 91±1. 05 mPa·s,较静脉血降低,差异均有统计学意义(P=0. 020,0. 041)。结论术中自体回收红细胞保持了良好的抗聚集能力和变形能力,能为气体交换提供足够的交换面积并变形通过毛细血管为组织供氧。综合考虑回收红细胞同时具有良好的携氧、释氧能力以及流变学性质,在术中需要输注红细胞时应首选自体回收红细胞。

Effects of intraoperative cell salvage on the rheology of red blood cells

Objective To evaluate the effects of intraoperative cell salvage on the rheology of red blood cells( RBCs) by analyzing the rheology parameters of intraoperative cell salvaged blood. Methods This was a prospective self-control study. Twenty patients scheduled for off-pump coronary artery bypass grafting surgery and planned to do cell salvage during operation from January to December 2018 in Beijing Friendship Hospital were recruited. The aggregation index,deformation index and whole blood viscosity of salvaged RBCs and the same patient’s venous blood were tested by viscometer. The same tests were done for the ten erythrocyte suspensions stored for 10-15 days. Results The aggregation index and deformation index were 4. 37 ± 0. 83 and 0. 84 ± 0. 22 of salvaged RBCs,4. 55 ± 0. 83 and 1. 01 ± 0. 25 of patient’s venous blood. There was no significant difference between them( P = 0. 413,0. 051). The whole blood viscosity at the shear rate of 200/s,30/s,5/s and 1/s were3. 40 ± 0. 54 m Pa·s,4. 36 ± 0. 84 m Pa·s,7. 12 ± 1. 85 m Pa·s and 15. 10 ± 5. 15 m Pa·s of salvaged RBCs,and 3. 15 ± 0. 90 m Pa·s,4. 05± 1. 18 m Pa·s,6. 67 ± 2. 06 m Pa·s and 14. 25 ± 4. 80 m Pa·s of the same patient’s venous blood,there was no significant difference between them( P = 0. 234,0. 310,0. 428,0. 543). The aggregation index and deformation index of erythrocyte suspensions were 4. 55 ± 1. 41,0. 91 ±0. 30,and there was no difference compared with the patient’s venous blood( P = 0. 892,0. 863). The whole blood viscosity at the shear rate of5/s and 1/s of the erythrocyte suspensions stored for 10-15 days were 6. 45 ± 1. 29 m Pa·s and 13. 79 ± 3. 35 m Pa·s respectively,and there was no difference compared with the patient’s venous blood( P = 0. 103,0. 203). The whole blood viscosity at the shear rate of 200/s and 30/s of the erythrocyte suspensions were 3. 08 ± 0. 58 m Pa·s and 3. 91 ± 1. 05 m Pa·s,both decreased significantly compared with the venous blood( P = 0. 020,0. 041). Conclusion Cell salvaged RBCs exhibit good anti-aggregation and deformation abilities,which can provide sufficient exchange area for gas exchange and deform to pass through the capillaries to supply oxygen for the tissue. Together with the good oxygen carrying and releasing capabilities,the cell salvaged blood is preferred for the patients when the RBC transfusion is needed during the operation.