自体血回收机对回收红细胞的破坏作用及川芎嗪保护作用的研究

目的　探讨回输自体血中红细胞的功能及川芎嗪对其的保护作用。方法　将 60例自体输血病人按随机数表的方法分为两组 ,每组 30例。Ⅰ组为实验组 ,于收集自体血前 30min经静脉滴注川芎嗪 4mg/kg ,然后在冲洗液内加入 5 %的川芎嗪 ,并用相同浓度的川芎嗪生理盐水洗涤红细胞。Ⅱ组为对照组 ,操作步骤同Ⅰ组 ,但冲洗液和洗涤液中不加川芎嗪。观察红细胞回输率、红细胞的形态、红细胞内游离钙浓度 ([Ca2 + ]i) ,并进行统计学处理。结果　两组病人红细胞洗涤前 [Ca2 + ]i组间差异无显著意义 ,洗涤后两组红细胞 [Ca2 + ]i都较洗涤前有明显的升高 (Ⅰ组为 34nmol/L± 1 0nmol/Lvs 48nmol/L± 1 7nmol/L ,Ⅱ组为 38nmol/L± 9nmol/Lvs76nmol/L± 2 3nmol/L) ,两组间差异有显著意义 (P <0 .0 5) ;其中Ⅱ组洗涤后 [Ca2 + ]i升高更明显 (P <0 .0 1 ) ;Ⅰ组自体血回输率明显高于Ⅱ组 (69%± 8%vs 50 %± 1 6 % ,P <0 .0 5) ;变形红细胞和红细胞碎片较Ⅱ组少。结论　红细胞在回收和洗涤过程中有一定的破损及功能异常 ,川芎嗪可能通过其钙阻滞作用、负性电荷作用、抗氧化作用等对回收、分离、洗涤的红细胞有保护作用 ,在自体血回输过程中应用能够提高回输血的质量和回输率 ,减少红细胞的破坏

Protective effect of tetramethylpyrazine on red blood cells during autotransfusion

OBJECTIVE: To evaluate the protective effect of tetramethylpyrazine (TMPZ) on red blood cells (RBCs) during autotransfusion. METHODS: Sixty patients undergoing autotransfusion were randomly divided into 2 groups, 30 in each. In group I TMPZ with the dose of 4 mg/kg was injected intravenously to the patients before their blood was collected and put into the washing fluid consisting of heparinized normal saline with the end concentration of 5%. In group II TMPZ of the same dose was given to the patients too but no TMPZ was put into the washing fluid. The retrieval rate of RBC was calculated according to formula. The morphology of RBCs was observed by microscopy. Fluorescence spectrometry was used to examine the free calcium concentration in RBCs ([Ca(2+)]i) in the venous blood before anesthesia and the retrieved blood of the same patients. RESULTS: There was no difference in the [Ca(2+)]i in RBCs before ther were washed between the two groups (P > 0.05). After the RBCs were washed, the [Ca(2+)]i increased in both groups (34 nmol/L +/- 10 nmol/L vs 48 nmol/L +/- 17 nmol/L in group I, P < 0.05; and 38 nmol/L +/- 9 nmol/L vs 76 nmol/L +/- 23 nmol/L in group II, P < 0.01), and the difference between the two groups were statistically significant (P < 0.05 approximately 0.01). The retrieval rate of RBCs was 69% +/- 8% in group I, higher than that in group II (50% +/- 16%, P < 0.05). Abnormal RBCs and fragments of RBCs were less in group I than in group II. CONCLUSION: RBCs undergo destruction to a certain degree during retrieval and washing. TMPZ protects RBCs from destruction through its calcium block, negative charge, and antioxidation effects. Pretreatment of the patients with TMPZ and addition of TMPZ into the washing fluid improve the quality of retrieved blood, increase the retrieval rate of blood, and decrease the destruction of RBCs.