自体输血对骨科手术患者抗感染免疫功能的影响

目的：探讨不同自体输血方式在骨科手术输血后对机体产生的抗感染免疫效应，为骨科手术合理用血提供科学的理论依据。方法：在征得患者知情同意的前提下，选取临床一般资料大致相似的择期手术患者60例随机分为4组，依次为异体输血组（allogeneic blood transfusion，ABT，G1）、血液稀释组（acutenomo-volamic haemodilution，ANH，G2）、血液回收组（Intraoperative Autotransfusion，IAT，G3）和血液稀释与血液回收两种方式联合应用组（ANH及IAT，G4）。以G1为对照组，其它三组为实验组，每组15例。各组均于术前及术后第1、7、14d清晨抽取空腹患者外周静脉血10ml，用于检测IgG、IgM、补体C3a、IL-8及TNF-α含量。结果：术前各组IgG、IgM、补体C3a、IL-8及TNF-α含量相比差异均无统计学意义（P〉0．05）。术后G1IgG、IgM较术前降低（P〈0．05），G2、3、4IgM较G1高且与G1相比差异有统计学意义（P〈0．05）。术后G2、3、4补体C3a/IL-8、TNF-α较术前均升高（P〈0．05），与G1相比差异有统计学意义（P〈0．05）。G4与G2、3相比，术后G4补体C3a、TNF-α较早升高且升高明显，术后第14dG4补体C3a较G3高且与G3相比差异有统计学意义（P〈0．05）。结论：①自体输血患者较异体输血患者输血后抗感染免疫能力增强。②血液稀释和血液回收两种自体输血方式单独应用对机体抗感染免疫能力的影响没有差异。③血液稀释和血液回收两种方式联合应用有助于提高机体的抗感染免疫能力，较单独应用抗感染免疫能力增强。

Effect on the Anti-infective Immunity Function by Autologous Transfusion in Patients Undergoing Orthopaedics Surgery

Objective： To explore anti-infective immunological effects of different autologous transfusion af- ter orthopaedic operations, and to further provide scientific theoretical proofs for reasonable using of blood during orthopaedic operations. Methods： Under the prerequisite of kowning fact and consent of the patients, 60 cases patients undertaken selective operation were choosed and divided into 4 groups at random with 15 for each group, all of which were in similar situation. The groups are ABT group（G1）、ANH group（G2）、 IAT group（G3）、group of combind ANH and IAT （ANH ＋ IAT）（G4）. Taking group I as the control, other 3 groups as experi- ment groups. The vein blood samples were taken before surgery and on the day 1、7、14 after surgery. Results： Before induction of operation the IgG、IgM、C3a、IL-8 and TNF-α in each group were not significantly different from those in other groups（P 〉 0.05）. Comparing with those at base line, the IgG decreased significantly（P〈0.05） in G1 after operation. Comparing with those at base line, the IgM decreased significantly（P 〈（0.05） in G1 after operation;and were significantly different from G2、G3 and G4 （P 〈（0.05）. Comparing with those at base line, the C3a、IL-8、TNF-α increased significantly（P 〈 0.05）in G2, G3 and G4 after operation;and were significantly different from group（P〈0.05）. Comparing with G2、G3, the C3a、TNF-α increased earlier and higher in G4; Comparing with G3,the C3a increased significantly（P 〈 0.05）in G4. Conclusion： Comparing allogeneic transfusion with autologous transfusion , the latter enhance anti - infective immunfunction . There is not signifi-cantly different between ANH and IAT in immune function . The combined method of ANH and IAT is more useful for the promotion of anti-infective immunfunction.