文章摘要

储存式自体输血在体外循环心脏瓣膜置换术患者中的应用效果

作者: 1邸艳辉, 1白宇, 1贾军会, 1白薇, 1寇立舵, 1王新华
1 航天中心医院输血科,北京 100049
通讯: 王新华 Email: wangxinhua721@163.com
DOI: 10.3978/j.issn.2095-6959.2022.04.019
基金: 北京市科技计划项目 (Z171100001017103)。

摘要

目的:探究储存式自体输血对体外循环心脏瓣膜置换术患者凝血功能、氧合状况及细胞免疫功能的影响。方法:选取2017年1月至2020年6月在航天中心医院进行体外循环心脏瓣膜置换术患者130例,按输血方式不同分为对照组(n=65)与观察组(n=65)。对照组进行异体输血,观察组进行储存式自体血回输。对比两组手术一般情况,术前1 d、术后1 d、术后5 d凝血功能[纤维蛋白原(fibrinogen,FIB)、活化部分凝血活酶时间(activated partial thromboplastin time,APTT)、凝血酶原时间(prothrombin time,PT)、D-二聚体(D-dimer,D-D)]、氧合状况[氧摄取率(oxygen extraction ratio,ERO2)、动脉血氧分压(partial pressure of oxygen in arterial blood,PaO2)、混合静脉血氧饱和度(mixed venous oxygen saturation,SvO2)]、免疫功能[辅助性T细胞(helper T cell,Th)、抑制性T细胞(suppressor T cell,Ts)、Th/Ts、自然杀伤细胞(natural killer cell,NK)]。结果:两组手术时间、体外循环时间、失血量、输血量比较差异无统计学意义(P>0.05);观察组术后1、5 d的FIB、APTT、PT、D-D水平均优于对照组(P<0.05);观察组术后1、5 d的PaO2、SvO2、Th、Th/Ts、NK高于对照组(P<0.05),ERO2、Ts低于对照组(P<0.05);观察组输血不良反应发生率为4.62%,低于对照组的15.38%(P<0.05)。结论:储存式自体输血对体外循环心脏瓣膜置换术患者凝血功能影响较小,可有效改善血液氧合状况及免疫功能,且具有良好安全性。
关键词: 心脏瓣膜置换术;体外循环;储存式自体输血;异体输血;凝血功能;氧合状况;细胞免疫功能

Application effect of stored autologous blood transfusion in patients undergoing cardiac valve replacement under cardiopulmonary bypass

Authors: 1DI Yanhui, 1BAI Yu, 1JIA Junhui, 1BAI Wei, 1KOU Liduo, 1WANG Xinhua
1 Department of Blood Transfusion, Aerospace Center Hospital, Beijing 100049, China

CorrespondingAuthor: WANG Xinhua Email: wangxinhua721@163.com

DOI: 10.3978/j.issn.2095-6959.2022.04.019

Foundation: This work was supported by the Beijing Science and Technology Planning Project, China (Z171100001017103).

Abstract

Objective: To investigate the effect of stored autologous blood transfusion on coagulation function, oxygenation and cellular immune function in patients undergoing cardiac valve replacement under cardiopulmonary bypass. Methods: A total of 130 patients undergoing cardiac valve replacement under cardiopulmonary bypass in our hospital from January 2017 to June 2020 were selected and divided into two groups according to different blood transfusion methods. Patients undergoing allogeneic blood transfusion were selected as the control group (n=65), and patients undergoing stored autologous blood transfusion were selected as the observation group (n=65). The general conditions of operation were compared between the two groups, and the coagulation function [fibrinogen (FIB), activated partial thromboplastin time (APTT), prothrombin time (PT), D-dimer (D-D)], oxygenation status [oxygen uptake rate (ERO2), arterial partial pressure of oxygen (PaO2), mixed venous oxygen saturation (SvO2)], immune function [helper T cells (Th), inhibitory T cells (Ts), Th/Ts, natural killer cells (NK)] 1 day before operation, 1 day after operation and 5 days after operation were compared between the two groups. Results: There was no significant difference in operation time, cardiopulmonary bypass time, blood loss and blood transfusion between the two groups (P>0.05). The levels of FIB, APTT, PT and D-D in the observation group were better than those in the control group at 1 d and 5 d after operation (P<0.05). PaO2, SvO2, Th, Th/Ts and NK in the observation group were higher than those in the control group (P<0.05), and ERO2 and Ts were lower than those in the control group (P<0.05). The incidence of adverse transfusion reactions in the observation group was 4.62%, which was lower than 15.38% in the control group (P<0.05). Conclusion: Storage autologous blood transfusion has little effect on coagulation function in patients undergoing cardiac valve replacement under cardiopulmonary bypass, which can effectively improve blood oxygenation and immune function, and has good safety.
Keywords: cardiac valve replacement; cardiopulmonary bypass; storage autologous blood transfusion; allogeneic blood transfusion; coagulation function; oxygenation status; cellular immune function