Autologous blood transfusion in the perioperative period of artificial total hip replacement
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摘要: 目的 研究分析自体血回输对人工全髋关节置换术患者凝血、免疫功能的影响。 方法 选取2013年8月—2015年3月行全髋关节置换术患者90例,根据数字表法将所有患者随机分为观察组(行自体血回输治疗)和对照组(行异体血输注治疗)。观察记录2组自体血回输量、异体血输注量、术后引流量,静脉抽血监测所有患者术前、输血后2 h、24 h的血常规及凝血检查,术前、术后1 d、3 d的T淋巴细胞亚群CD3+、CD4+、CD8+、自然杀伤细胞(NK细胞),计算CD4+/CD8+值,以及LgM、LgG、TNF-α数值。 结果 2组患者输血后2 h、24 h的Hb、Hct、PTL、APTT、ACT指标均低于手术前,两项指标在输血后24 h较输血后2 h有所提高,但均低于术前,比较差异具有统计学意义(P<0.05);2组输血后2 h PT高于术前,输血后24 h均有所降低;2组输血后FIB水平值低于术前,输血后24 h低于输血后2 h,但低于术前,比较差异具有统计学意义(P<0.05)。异体输血组输血后24 h的CD3+、CD4+、CD4+/CD8+、NK细胞指标水平均较术前显著减少,而CD8+略增加,输血后72 h异体输血组CD3+、CD4+、CD4+/CD8+、NK细胞数量继续降低,CD8+数值略增加,比较差异具有统计学意义(P<0.05)。2组术前LgM、LgG、TNF-α水平数值差别无统计学意义(P>0.05);2组组术后24 h、72 h的LgM、LgG均低于术前(P<0.05);观察组术后24 h、72 h的LgM、LgG、TNF-α水平数值均高于对照组(P<0.05)。 结论 自体血回输对患者免疫功能影响小,且可解决血源紧缺问题,防止异体血液输注所引起的不良并发症发生。Abstract: Objective To Analyze the effect of autologous blood transfusion replacement on the blood clotting,immune function of patients with total hip arthroplasty. Methods From August 2013 to March 2015 90 cases of total hip arthroplasty patients in our hospital were chosen,according to the number table all the patients were randomly divided into two groups(autologous blood transfusion therapy) and control group(row allogeneic blood transfusion NOTE treatment).Both groups were recorded amount of autologous blood transfusion,allogeneic blood transfusion,postoperative drainage,venous blood monitoring all patients,blood and coagulation Checker 2 h,24 h after transfusion,preoperative and postoperative 1 d,3 d of T lymphocyte subsets CD3+,CD4+,CD8+,natural killer cells(NK cells),calculated CD4+/CD8+ value,and LgM,LgG,TNF-α values. Results Hb,Hct,PTL,APTT,ACT indicators in the two groups of patients before transfusion were lower than 24 h operation,two indicators have 2 h after blood transfusion after transfusion 24 h relatively improved,but were lower than the preoperative,and the difference statistically significant(P<0.05);the two groups after transfusion 2 h PT higher than before surgery,24 h were decreased after transfusion;transfusion after two FIB level lower than the preoperative value,less than 24 h after transfusion after transfusion 2 h,but lower than that before surgery,the difference was statistically significant(P<0.05).After the transfusion 24 h of CD3+,CD4+,CD4+/CD8+,NK cell index compared with surgery significantly reduced allogeneic blood transfusion group,but CD8+ slightly increased after transfusion 72 h allogeneic transfusion group CD3+,CD4+,CD4+/CD8+,the number of NK cells continue to reduce,CD8+ value slightly increased,the difference was statistically significant(P<0.05).Preoperative LgM,LgG,TNF-α levels were not significant differences(P>0.05);two groups after 24 h,72 h of LgM,LgG were lower than the preoperative,and the difference statistically significant(P<0.05);observation group after 24 h,72 h of LgM,LgG,TNF-α levels were higher values(P<0.05). Conclusion Autologous blood transfusion has little effect on immune function,and the blood shortage problem solve and prevent undesirable complication of allogeneic blood transfusion caused the occurrence.
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