Muñoz M, Cobos A, Campos A, Ariza D, Muñoz E, Gómez A
GIEMSA, School of Medicine, University of Málaga, Malaga, Spain.
Acta Anaesthesiol Scand. 2006 Apr;50(4):443-50. doi: 10.1111/j.1399-6576.2006.00977.x.
In patients undergoing total knee replacement (TKR), most blood loss occurs post-operatively, and the return of unwashed filtered shed blood (USB) from post-operative drainage may represent an alternative to allogeneic blood transfusion (ABT). We evaluated the impact of USB return on the cellular immune response (CIR) after TKR.
Forty TKR patients, intended to receive post-operative USB, entered the study. Blood samples were obtained before and 6 h, 24 h, 72 h and 7 days after surgery, and from USB, after it had been passed through a 40-microm filter. Full blood cell counts, lymphocyte subsets and immunoglobulins (IgA, IgG, IgM) were measured in all samples. A set of clinical data was collected from each patient.
Twenty-four of the 25 patients received a mean of 1.2 USB units and did not need additional ABT (USB group). Twelve of the 15 remaining patients who received neither USB nor ABT served as a control group for the post-operative CIR study. All patients showed a post-operative decrease in T-cell and natural killer (NK) cell counts, but not B-cell counts, and there were no significant differences between the groups with regard to CIR parameters, post-operative infection or hospital stay.
Post-operative salvage and return of USB after TKR does not seem to increase the post-operative infection rate or hospital stay, and does not modify CIR induced by surgery. These findings add to the clinical experience that post-operative USB return, as a source of autologous blood, is safe, and questions the beneficial effect of blood washing.
在接受全膝关节置换术（TKR）的患者中，大部分失血发生在术后，术后引流液中未洗涤过滤的回收失血（USB）回输可能是同种异体输血（ABT）的一种替代方法。我们评估了USB回输对TKR术后细胞免疫反应（CIR）的影响。
40例计划接受术后USB回输的TKR患者进入本研究。在手术前、术后6小时、24小时、72小时和7天采集血样，并在USB通过40微米过滤器后采集。检测所有样本的全血细胞计数、淋巴细胞亚群和免疫球蛋白（IgA、IgG、IgM）。收集每位患者的一组临床数据。
25例患者中的24例平均接受了1.2个USB单位的回输，且无需额外的ABT（USB组）。其余15例既未接受USB回输也未接受ABT的患者中的12例作为术后CIR研究的对照组。所有患者术后T细胞和自然杀伤（NK）细胞计数均下降，但B细胞计数未下降，两组在CIR参数、术后感染或住院时间方面无显著差异。
TKR术后USB的回收和回输似乎不会增加术后感染率或住院时间，也不会改变手术诱导的CIR。这些发现进一步丰富了临床经验，即术后USB回输作为自体血来源是安全的，并对血液洗涤的有益效果提出了质疑。
