Southern E P, Huo M H, Mehta J R, Keggi K J
Department of Orthopaedic Surgery, Yale University School of Medicine, New Haven, CT 06520-8071, USA.
Clin Orthop Relat Res. 1995 Nov(320):235-46.
Wound drainage blood was collected after total joint arthroplasty was completed in 13 consecutive patients. Peripheral blood samples were collected in the recovery room and at 6 hours postoperatively for all 13 patients. A standard enzyme-linked immunosorbency assay was done to quantify tumor necrosis factor-alpha, interleukin-1 alpha, interleukin-6, and interleukin-8 levels in the samples. At 6 hours postoperatively, the levels of cytokines were elevated significantly in the peripheral and drainage blood serum. In particular, the drainage blood serum had the most dramatic increase for all cytokines, which was significant. Reinfusion of unwashed filtered postoperative wound drainage blood has been shown not to be entirely benign; pyrogenic transfusion reaction is the most commonly reported adverse effect, but hemodynamic instability with hypotension and even myocardial infarction have been reported. The cause of these adverse events has not been defined clearly, but may be secondary to the infusion of cytokines. The present study showed the presence and significant elevation of the cytokine levels in the wound drainage blood. A comprehensive review of the literature revealed that unwashed drainage blood is a relatively dilute blood product lacking normal clotting factors and having numerous other undesirable components that may mitigate against its routine use in lieu of predeposited autologous or homologous blood. This is of interest because there is evidence indicating that wound drainage blood reinfusion may be unnecessary in total joint arthroplasty when autologous blood is available. Use of drains in this surgery also may be unnecessary and has been shown to increase the amount of blood loss and the need for transfusion.
在连续13例患者完成全关节置换术后收集伤口引流血。对所有13例患者在恢复室及术后6小时采集外周血样本。采用标准酶联免疫吸附测定法对样本中的肿瘤坏死因子-α、白细胞介素-1α、白细胞介素-6和白细胞介素-8水平进行定量。术后6小时，外周血和引流血清中的细胞因子水平显著升高。特别是，所有细胞因子在引流血清中的升高最为显著，具有统计学意义。已表明回输未洗涤过滤的术后伤口引流血并非完全无害；热原性输血反应是最常报道的不良反应，但也有报道出现伴有低血压的血流动力学不稳定甚至心肌梗死。这些不良事件的原因尚未明确界定，但可能继发于细胞因子的输注。本研究显示伤口引流血中存在细胞因子且水平显著升高。对文献的全面回顾表明，未洗涤的引流血是一种相对稀释的血液制品，缺乏正常凝血因子且含有许多其他不良成分，这可能不利于其常规替代预存自体血或同源血使用。这一点值得关注，因为有证据表明，在有自体血可用的情况下，全关节置换术中回输伤口引流血可能并无必要。在该手术中使用引流管也可能不必要，并且已表明会增加失血量和输血需求。
