体外循环中血液冲洗及自体输血对红细胞免疫和肾功能的影响
[Effects of blood washing and autotransfusion during cardiopulmonary bypass on erythrocyte immune and kidney function].
作者信息
Song Yi, Li Ran, Gu Xing-hua, Gong Xing-jun, Zhang Gong, Wu Shu-ming, Zhang Xi-quan, Li Shou-xian
机构信息
Qilu Hospital, Shandong University, Jinan 250012, China.
出版信息
Zhonghua Yi Xue Za Zhi. 2006 Aug 29;86(32):2293-6.
OBJECTIVE
To study changes of erythrocyte immune and kidney function after autotransfusion washed red blood cells during cardiopulmonary bypass (CPB).
METHODS
Thirty-two patients undergoing valve replacement with CPB were randomly divided into study group and control group (16 in each group). In study group, the blood in operative field and the residual blood in the extracorporal machine were collected, centrifuged, washed and retransfused to patients. Patients in control group were transfused with the residual blood in the extracorporal machine without any disposal or banked blood. All patients were used with membrane oxygenator. Before CPB, 12 h, 24 h, 72 h and 7 d after CPB, whole blood were taken, then the erythrocyte immune function (C3bRR, RICR) and level of plasma free hemoglobin (FHB) were assayed, and post-operation renal function was compared between the two groups. Moreover, total volume of banked blood transfused to patients after CPB was recorded.
RESULTS
(1) After 12 hours, 24 hours, 72 hours, 7 days of CPB, the RBC-C3bRR (14.3% +/- 4.7%, 15.9% +/- 3.6%, 16.6% +/- 2.8%, 19.9% +/- 4.1%) and RBC-ICR (8.7% +/- 1.9%, 9.2% +/- 2.0%, 9.5% +/- 2.6%, 12.0% +/- 2.0%) in study group were significantly elevated than that in control group (RBC-C3bRR 10.7% +/- 2.4%, 11.3% +/- 3.0%, 12.3% +/- 3.5%, 14.5% +/- 2.0%, RBC-ICR 5.9% +/- 1.4%, 6.0% +/- 1.8%, 7.0% +/- 1.7%, 8.7% +/- 2.7%). The erythrocyte immune function after CPB was better and restored faster in study group than that in control group (P < 0.05 in all). (2) After 12 hours, 24 hours of CPB, the levels of FHB (0.41 g/L +/- 0.13 g/L, 0.03 g/L +/- 0.02 g/L) in study group were significantly lower than that in control group (1.02 g/L +/- 0.23 g/L, 0.54 g/L +/- 0.09 g/L) (P < 0.01). After 24 hours of CPB, the level of urinary protein excretion (0.19 g/d +/- 0.08 g/d) in study group was significantly lower than that in control group (0.32 g/d +/- 0.07 g/d) (P < 0.05). (3) After 24 hours of CPB, the level of 24 h creatinine clearance was significantly elevated in study group (68 ml x min(-1) x 1.73 m(-2) +/- 10 ml x min(-1) x 1.73 m(-2)) than that in control group (45 ml x min(-1) x 1.73 m(-2) +/- 4 ml x min(-1) x 1.73 m(-2)) (P < 0.01). (4) The total volume of banked RBCs transfused after CPB were fewer in study group (2.0 U +/- 1.1 U) than that in control group (7.4 U +/- 2.3 U) (P < 0.01).
CONCLUSION
Autotransfusion of washed red blood cells during CPB may improve significantly the erythrocyte immune function and protect kidney function better than transfusion of residual blood in the extracorporal machine or banked blood.
目的
研究体外循环（CPB）期间自体洗涤红细胞回输后红细胞免疫及肾功能的变化。
方法
32例行CPB下瓣膜置换术的患者随机分为研究组和对照组（每组16例）。研究组收集手术野血液及体外循环机内剩余血液，经离心、洗涤后回输给患者。对照组输注体外循环机内未经处理的剩余血液或库存血。所有患者均使用膜式氧合器。于CPB前、CPB后12 h、24 h、72 h及7 d采集全血，检测红细胞免疫功能（C3bRR、RICR）及血浆游离血红蛋白（FHB）水平，并比较两组术后肾功能。此外，记录CPB后患者输注库存血的总量。
结果
（1）CPB后12 h、24 h、72 h、7 d，研究组红细胞C3bRR（14.3%±4.7%、15.9%±3.6%、16.6%±2.8%、19.9%±4.1%）及红细胞ICR（8.7%±1.9 %、9.2%±2.0%、9.5%±2.6%、12.0%±2.0%）均显著高于对照组（红细胞C3bRR 10.7%±2.4%、11.3%±3.0%、12.3%±3.5%、14.5%±2.0%，红细胞ICR 5.9%±1.4%、6.0%±1.8%、7.0%±1.7%、8.7%±2.7%）。研究组CPB后红细胞免疫功能优于对照组，恢复也更快（均P<0.05）。（2）CPB后12 h、24 h，研究组FHB水平（0.41 g/L±0.13 g/L、0.03 g/L±0.02 g/L）显著低于对照组（1.02 g/L±0.23 g/L、0.54 g/L±0.09 g/L）（P<0.01）。CPB后24 h，研究组尿蛋白排泄量（0.19 g/d±0.08 g/d）显著低于对照组（0.32 g/d±0.07 g/d）（P<0.05）。（3）CPB后24 h，研究组24 h肌酐清除率显著高于对照组（68 ml·min-1·1.73 m-2±10 ml·min-1·1.73 m-2）（45 ml·min-1·1.73 m-2±4 ml·min-1·1.73 m-2）（P<0.01）。（4）CPB后研究组输注库存红细胞总量（2.0 U±1.1 U）少于对照组（7.4 U±2.3 U）（P<0.01）。
结论
CPB期间自体洗涤红细胞回输较输注体外循环机内剩余血液或库存血可显著改善红细胞免疫功能，并更好地保护肾功能。
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