国际麻醉学与复苏杂志   2018, Issue (3): 0-0
    
洗涤式自体血液回收对糖尿病骨科手术患者红细胞相关指标的影响
周晓芳, 徐佳明, 程勇, 郭建荣1()
1.第二军医大学附属公利医院
Effect of intraoperative blood salvage on related indexes of erythrocyte in orthopedic surgery of diabetic patients
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摘要:

目的 观察合并糖尿病的骨科手术患者术中应用洗涤式自体血液回收后红细胞相关指标的变化和对红细胞回收率的影响。 方法 择期骨科手术病例70例,分为7组,每组10例。合并糖尿病者根据病史以及糖化血红蛋白(hemoglobin A1c,HbA1c)水平纳入如下6组:病史0~5年、HbA1c控制在7%以内为 A1组,大于7%为A2组;病史6~10年、HbA1c在7%以内为B1组,大于7%为B2组;大于10年,HbA1c小于7%为 C1组,大于7%为C2组。无糖尿病者纳入对照D组。比较各组患者出血量、回收血量和红细胞回收率等。在术前(T0)、血液回收后(T1)以及洗涤后(T2)三个时间点各取5ml血液标本,检测红细胞相关指标和血气电解质。结果 与D组(60.1±5.3)%比较,B2组(55.2±4.9)%、C2组(52.9±2.7)%红细胞回收率略低(P<0.05)。在T0,与D组比较,B2、C1和C2组红细胞平均体积(erythrocyte mean corpuscular volume,MCV)均增大,且C2组大于A1组(P<0.05)。在T0与T1点,与D组相比,A2、B2、C1和C2组红细胞分布宽度(red blood cell distribution width,RDW)均增宽;与A1组相比,B2和C2 组RDW增宽(P<0.05)。与T0点比较,各组血液标本pH和Na+值在T1和T2均显著上升(P<0.05)。而各组K+在T1均显著上升,在T2下降至低于T0水平(P<0.05)。各组患者回收后(T2)血液标本红细胞相关指标和pH、Na+以及K+差异均无统计学意义(P>0.05)。结论 HbA1c控制不佳的糖尿病骨科手术患者经洗涤式自体血液回收后红细胞相关指标有改变,回收率降低,但可以安全回输。

关键词: 自体血液回收;红常规;糖尿病;骨科手术
Abstract:

Objective To explore the effect of intraoperative blood salvage on indexes of erythrocyte in orthopedic surgery of diabetic patients.Methods A total of 70 patients undergoing selective orthopaedics surgery were included in this study.They were divided into 7 groups with 10 patients each.Non-diabetes served as control (Group D).The others were divided into 6 groups according to the diabetes history and the level of hemoglobin A1c (HbA1c). 0 to 5-year diabetics whose HbA1c level lower than 7% were incorporated into Group A1,while those whose HbA1c level above 7% belong to group A2,6 to 10-year diabetics were assigned into Group B1 ( HbA1c level less than 7% ) and B2 (more than 7% ).More than 10 years diabetics were incorporated into Group C1 ( HbA1c level less than 7% ) and C2 (more than 7% ).The amount of bleeding,blood salvage and erythrocyte recovery rates were compared among the seven groups.5ml blood samples were drawn at three time points,including preoperation(T0),after blood collection (T1) and washing (T2),and then blood gas analysis and erythrocyte related index were tested.Results The red blood cell recovery of group B2 (55.2±4.9) % and C2 (52.9±2.7) % dpressed as compared with control(60.1±5.3)% (P<0.05). At T0,the erythrocyte mean corpuscular volume of group B2,C1 and C2 rised compared with group D,and goup C2 was higher than group A1(P<0.05).The red blood cell distribution width in group A2,B2,C1 and C2 was evidently broadened than group D at T0 and T1.And group B2 and C2 showed increased width compared with group A1(P<0.05).The level of pH and Na+ of each group increased quite significantly at T1 and T2 as compared with T0(P<0.05).The K+ concentration of each group rised significant at T1 and reduced below the level of T0 at T2(P<0.05). There was no difference among all the erythrocyte related index, pH,Na+ and K+ at T2. Conclusions The recovery rates of erythrocyte in diabetic patients those whose HbA1c were poorly controlled were declined.But the salvaged blood could be retransfused safely. 【Key words】

Key words: Intraoperative blood salvage;Blood routine;Diabetes;Orthopedic surgery;