Arnestad J P, Hyllner M, Bengtson J P, Tylman M, Mollnes T E, Bengtsson A
Department of Anaesthesiology & Intensive Care, Sahlgrenska University Hospital, Göteborg, Sweden.
Acta Anaesthesiol Scand. 1998 Aug;42(7):811-5. doi: 10.1111/j.1399-6576.1998.tb05327.x.
Perioperative blood salvage is associated with release of inflammatory mediators. Depending on type of processing, the complement system is activated to some extent in the final blood product. The aim of the present study was to evaluate a haemofiltration technique concerning complement system activation and whether the volume of added saline will have an influence on the elimination of activated complement during processing.
Sixteen patients undergoing total hip arthroplasty received wound blood salvaged intraoperatively with a haemofiltration technique. Saline was added to the reservoir for washing in a ratio of 1:1 or 5:1 of estimated blood volume. Samples for determination of the anaphylatoxins C3a and C5a, and the terminal SC5b-9 complement complex (TCC) were drawn from the patients, the collected blood, the ultrafiltrate and the processed blood.
Increased concentrations of C3a, C5a and TCC were found in aspirated and processed blood. Haemofiltration did not reduce the concentrations of these factors, except that of C3a in the group where saline was added in a ratio of 5:1. There were no increased concentrations of C3a, C5a or TCC in the patient plasma after reinfusion. No differences in blood pressure, heart rate, pH, arterial oxygen tension, arterial carbon dioxide tension, or base excess were found in association with reinfusion of the blood.
Collected shed blood washed through haemofiltration contained moderately elevated concentrations of C3a, C5a and TCC. Reinfusion of the blood neither led to increased systemic concentrations of complement activation products, nor to disturbances in haemodynamic or biochemical parameters.
围手术期血液回收与炎症介质的释放有关。根据处理方式的不同，最终的血液制品中补体系统会在一定程度上被激活。本研究的目的是评估一种血液滤过技术对补体系统激活的影响，以及添加生理盐水的量是否会对处理过程中激活补体的清除产生影响。
16例行全髋关节置换术的患者术中采用血液滤过技术回收伤口血液。以估计血容量1:1或5:1的比例向储血器中添加生理盐水进行冲洗。从患者、收集的血液、超滤液和处理后的血液中采集样本，用于测定过敏毒素C3a和C5a以及终末补体复合物SC5b-9（TCC）。
在吸出的血液和处理后的血液中发现C3a、C5a和TCC的浓度升高。血液滤过并未降低这些因子的浓度，但在以5:1比例添加生理盐水的组中，C3a的浓度有所降低。回输后患者血浆中C3a、C5a或TCC的浓度没有升高。回输血液后，血压、心率、pH值、动脉血氧分压、动脉血二氧化碳分压或碱剩余均未发现差异。
通过血液滤过冲洗收集的失血中，C3a、C5a和TCC的浓度适度升高。回输这些血液既不会导致补体激活产物的全身浓度升高，也不会引起血流动力学或生化参数的紊乱。
