等容稀释性自体输血对妇科恶性肿瘤患者围手术期免疫功能的影响

目的：本文旨在对妇科恶性肿瘤患者术中等容稀释性自体输血（ANH）初期研究的基础上，探讨异体输血及ANH对妇科恶性肿瘤患者围手术期机体免疫功能的影响差异。方法：选择妇科恶性肿瘤患者40例，随机分为2组。等容稀释性自体输血组（I组）：于麻醉后手术切皮前经桡动脉放血400～600ml,同时经静脉输入相当容量的羟乙基淀粉，手术后半阶段将自体血回输；异体输血组（Ⅱ组）：术中输异体悬浮红细胞2～3U。分别于术前、术后1d、术后5d抽取静脉血，用流式细胞仪测定外周血中自然杀伤细胞（NK）、巨噬细胞、IL系列因子、IgG、IgM、CD3^＋、CD4^＋、CD4^＋／CD8^＋的变化情况。结果：①2组术后1dCD3^＋、CD4^＋、CD4^＋／CD8^＋较术前显著减少，其中Ⅱ组较I组减少更明显，NK细胞升高（P〈O．05）；术后5dⅡ组CD3^＋、CD4^＋、CD4^＋／CD8^＋仍较术前显著减少，而I组均基本恢复正常，且I组CD3^＋、CD4^＋高于Ⅱ组（P〈O．05）。②术后1dIgA、lgG2组均减少．IL-6、IL-8、TNF-α2组均升高，2组差异有统计学意义（P〈O．05）；术后5dI组均基本恢复正常，Ⅱ组与术前相比，差异有统计学意义（P〈0．05）；IgM2组变化不显著，差异无统计学意义。结论：自体输血对患者免疫功能影响较小，对机体细胞免疫功能无明显抑制作用，而异体输血对免疫功能抑制明显。围手术期自体输血较异体输血具有明显的优越性。

Influence of normovolemic hemodilution autologous transfusion on immune function of perioperative patients with gynecological malignancies

Objective：To investigate the acute normovolemic hemodilution autologous transfusion（ANH） in the patients with gynecological malignancies, and explore the difference of influence on immune function of perioperative patients with gynecological malignancies between allogeneic blood transfusion and ANH. Method：40 patients with gynecological cancer were randomly divided into two groups. ANH （group Ⅰ ） ： bloodletting 400 ～ 600ml through radial artery before surgical incision after anesthesia,while a considerable capacity of hydroxyethyl starch was intravenous infused, autologous blood transfusion was done among the bottom half of surgery. Allogeneic blood transfusion group （group Ⅱ） ：2 to 3 units of allogeneic red blood cell suspension were infused during operation. Venous blood samples were drawn before surgery,after surgery 1 day and 5 days. Natural killer cells （NK）, macrophages,IL series of factors, IgG, IgM, CD3-. CD4~, CD4~/ CD8＋ in peripheral blood were measured by flow cytometry. Result：①After operation 1 day, CD3^＋ ,CD4^＋ and CD4^＋/ CD8^＋ were significantly reduced com- pared with that before operation,which in group Ⅱ decreased more obvious than that in group I ,while NK cells increased（P〈0.05）. 5 days after operation in group Ⅱ CD3^＋ , CD4^＋ and CD4^＋ / CD8^＋ were still significantly reduced before surgery,but were returned to normal in group I and I group CD3^＋ and CD4^＋ were higher than that of group Ⅱ （P〈0.05）. ②after surgery 1 day IgA and lgG decreased in both groups, IL-6, IL-8, TNF-a increased in both groups, and the difference between the two groups was significant（P〈0.05）. 5 days after surgery both returned to normal in group I , Ⅱ group compared with before surgery, the difference was significant（P〈0. 05）. IgM in the two groups did not change significantly, the difference was not significant（P〉 0. 05）. Conclusion： ANH had little effect on immune function of patients, had no significant inhibitory effect,while allogeneic blood transfusion had significant inhibition on immune function. Perioperative autologous blood transfusion might have obvious suDerioritv to allogeneic blood transfusion.