预存式联合自体回收式输血对人工关节置换术患者凝血功能及细胞免疫功能的影响

[目的]探讨预存式联合自体回收式输血对人工关节置换术患者凝血功能及细胞免疫功能的影响.[方法]选取2013年1月至2016年1月在首都医科大学附属北京同仁医院和中国人民解放军总医院行人工全髋关节置换术患者92例,随机分为两组:观察组采用预存式联合回收式自体输血,对照组采用异体输血,比较两组患者术后的感染率、血常规指标[红细胞(RBC)、血红蛋白(Hb)、血小板(PLT)]、凝血功能指标[纤维蛋白原(FIB)、凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)和凝血时间(TT)]及细胞免疫功能(CD3+、CD4+、CD8+、CD4+/CD8+及NK)的变化.[结果]观察组感染率2.17%(1/46),与对照组8.70%(4/46)比较差异无统计学意义(χ2=1.904,P>0.05);两组患者输血后2h及24h的Hb、Hct、PLT、FIB、PT、APTT及TT比较差异无统计学意义(P>0.05);与术前比较,对照组输血后24h及72h的CD3+、CD4+、CD4+/CD8+及NK显著下降(P<0.05),观察组24h的CD3+、CD4+、CD4+/CD8+及NK显著下降(P<0.05),72h的上述指标无明显变化(P>0.05).两组患者输血后CD3+、CD4+、CD4+/CD8+及NK比较差异有统计学意义(P<0.05).[结论]预存式联合回收式自体输血安全有效,且对免疫功能无明显抑制,优于异体输血.

Influence of Predeposited Combined with Salvaged Autotransfusion on Blood Clotting and Cellular Immune Function of Patients with Total Hip Arthroplasty

[Objective]To study the influence of predeposited combined with salvaged autotransfusion on blood clot-ting and cellular immune function of patients with total hip arthroplasty.[Methods]From January 2013 to January 2016, 92 patients with total hip arthroplasty were selected from Beijing Tongren Hospital,Capital Medical University and Gen-eral Hospital of PLA.Patients were divided into 2 groups randomly,:with 46 patients in the observation group(auto-transfusion)and 46 patients in the control group(allogenic transfusion).The infection rate,blood routine(Hb,Hct and PLT),coagulation routine(FIB,PT,APTT and TT)and cellular immune function(CD3+,CD4+,CD8+,CD4+/CD8+and NK)were compared between the two groups.[Results]The infection rate in the observation group was 2.17%(1/46),which was not significantly different from that in the control group 8.70%(4/46)(χ2=1.904,P >0.05).There were no significant differences in Hb,Hct,PLT,FIB,PT,and APTT at 2h and 24h after transfusion between the two groups(P >0.05).Compared to preoperative values,,the levels of CD3+,CD4+,CD4+/CD8+and NK at 24h and 72h after transfusion in the control group decreased significantly(P <0.05).The levels of CD3+,CD4+,CD4+/CD8+and NK in the observation group decreased significantly at 24h(P <0.05);however,there was no significant changes at 72h (P >0.05).There were significant differences in CD3+,CD4+,CD4+/CD8+and NK between the two groups after transfusion(P <0.05).[Conclusion]:The safe and effective way of predeposited combined with salvaged autotransfu-sion has no impact on immune function.Thus it is superior to allogenic blood transfusion.