碳酸氢盐缓冲液与等渗盐溶液作为红细胞洗涤液的比较。

Comparison of bicarbonate-buffered fluid and isotonic saline solution as Cell Saver washing fluids for packed red blood cells.

作者信息

Huber Dirk, Witt Lars, Sümpelmann Robert, Heinze Larissa, Müller Thomas, Lichtinghagen Ralf, Osthaus Wilhelm A

机构信息

Department of Anaesthesiology and Intensive Care Medicine, Hanover Medical School, Hanover, Germany.

出版信息

Paediatr Anaesth. 2013 Nov;23(11):1021-6. doi: 10.1111/pan.12232. Epub 2013 Aug 1.

DOI:10.1111/pan.12232

PMID:23910018

Abstract

OBJECTIVES

Massive transfusion (MT) can cause severe electrolyte and acid-base disturbances in neonates and infants due to the unphysiological composition of packed red blood cells (PRBCs). Washing of the PRBCs using Cell Saver systems prior to MT is recommended for this reason.

AIM

The composition of normal saline (NaCl), the standard wash fluid for Cell Saver systems, is considerably different from that of physiological plasma. The aim of the study presented here was to investigate the effect of washing the PRBCs with a bicarbonate-buffered hemofiltration solution (BB-HS) in comparison with washing with NaCl and to evaluate the impact on electrolyte concentrations, acid-base balance and the stability of PRBCs.

METHODS

In an experimental in vitro setting, PRBCs were washed with Cell Saver systems prepared with NaCl or BB-HS as washing solutions. Before and after the washing procedure, electrolyte concentrations, acid-base parameters, adenosine triphosphate (ATP) and free hemoglobin (fHb) concentrations were measured.

RESULTS

In both groups, the potassium concentrations decreased (baseline: 18.4 ± 5.17 mmol·l(-1), end of study: NaCl 2.71 ± 1,81 mmol·l(-1), BB-HS 2.50 ± 1.54 mmol·l(-1), P < 0.05) while the acid-base balance improved only in the BB-HS-group (baseline: base excess -21.6 ± 3.52 mmol·l(-1), end of study: NaCl -30.2 ± 1.42 mmol·l(-1), BB-HS -7.51 ± 2.49 mmol·l(-1) , P < 0.05). Furthermore, markers of erythrocyte stability such as fHb and ATP concentrations were improved in the BB-HS-group.

CONCLUSIONS

Washing of PRBCs with BB-HS rather than NaCl results in a more physiological composition with improvements of electrolyte concentrations, acid-base balance and erythrocyte stability.

摘要

目的

由于浓缩红细胞（PRBCs）的成分不符合生理状态，大量输血（MT）可导致新生儿和婴儿出现严重的电解质和酸碱紊乱。因此，建议在MT前使用细胞回收系统对PRBCs进行洗涤。

目的

细胞回收系统的标准洗涤液生理盐水（NaCl）的成分与生理血浆有很大差异。本研究的目的是研究用碳酸氢盐缓冲血液滤过液（BB-HS）洗涤PRBCs与用NaCl洗涤相比的效果，并评估对电解质浓度、酸碱平衡和PRBCs稳定性的影响。

方法

在体外实验中，用NaCl或BB-HS作为洗涤液制备的细胞回收系统对PRBCs进行洗涤。在洗涤前后，测量电解质浓度、酸碱参数、三磷酸腺苷（ATP）和游离血红蛋白（fHb）浓度。

结果

两组的钾浓度均降低（基线：18.4±5.17 mmol·l(-1)，研究结束时：NaCl 2.71±1.81 mmol·l(-1)，BB-HS 2.50±1.54 mmol·l(-1)，P<0.05），而酸碱平衡仅在BB-HS组得到改善（基线：碱剩余-21.6±3.52 mmol·l(-1)，研究结束时：NaCl -30.2±1.42 mmol·l(-1)，BB-HS -7.51±2.49 mmol·l(-1)，P<0.05）。此外，BB-HS组中红细胞稳定性标志物如fHb和ATP浓度得到改善。