滤除白细胞自体回收血对围术期患者红细胞免疫功能及全身炎症反应的影响

摘要：Objective To investigate the effect of leukocyte-depleted intraoperative salvaged blood on the erythrocyte immunity and systemic inflammatory response during the perioperative period in patients.Methods Twenty ASA Ⅰ or Ⅱ patients (aged 20-44 years and weighing 40-75 kg) requiring blood salvage during operation (with the estimated intraoperative blood loss of 15-20 ml/kg) were randomly divided into two groups (n =10 each):control group (group C) and leukocyte depletion group (group D).Anesthesia was induced with midazolam,fentanyl,propofol and vecuronium and maintained with isoflurane inhalation and intravenous infusion of propofol and remifentanil.The patients were mechanically ventilated after endotracheal intubation.Intraoperative blood salvage and reinfusion were performed in all the patients.In group D,the salvaged blood was filtered by a leukocyte depletion filter placed in the line of the reinfusion circuit.Blood samples were collected from the central vein before anesthesia (T1),at the end of surgery (T2) and 12 hours (T3) and 36 hours (T4) after operation in all the patients.The rosette rates of red blood cell-C3b receptors (RBC-C3bRR) and RBC-immune complex (RBC-ICR) were determined.The number of leukocytes and polymorphonuclear neutrophils (PMNs) were counted.The plasma levels of interieukin-6 (IL-6),tumor necrosis factor-alpha (TNF-α) and malondialdehyde (MDA) were measured,too.Results Compared with group C,the plasma levels of IL-6,TNF-α and MDA were significantly lower at T2-T4,the RBC-C3bRR was significantly higher at T3-T4 (P ＜ 0.01),and the number of PMNs was significantly lower at T4 in group D(P＜0.05).Conclusion Leukocyte-depleted intraoperative salvaged blood is helpful to improve the erythrocyte immunity during the perioperative period in patients,and the decrease of systemic inflammatory response may be involved in the mechanism.