【作者】 王爱桃；

【导师】 温树正； 崔永武；

【作者基本信息】 内蒙古医学院 ， 外科学， 2007， 硕士

【摘要】 目的探索不同自体输血方式在骨科手术输血后对机体产生的抗感染免疫效应,为骨科手术合理用血提供科学的理论依据。方法在征得患者知情同意的前提下,选取临床一般资料大致相似的择期手术患者60例,随机分为四组,每组15例,依次为异体输血组(allogeneic blood transfusion,ABT)(GroupⅠ,G1)、血液稀释组(acute nomovolamic haemodilution,ANH)(GroupⅡ,G2)、血液回收组(intraoperative autotransfusion,IAT)(GroupⅢ,G3)和血液稀释与血液回收两种方式联合应用组(ANH及IAT)(GroupⅣ,G4)。各组均于术前及术后第1、7、14天清晨抽取空腹患者外周静脉血10ml,用于检测IgG、IgM、补体C3a、IL-8及TNF-α含量;采用免疫投射比浊法测定IgG、IgM含量,采用放射免疫法测定补体C3a、炎症细胞因子IL-8及TNF-α含量。结果术前各组IgG、IgM、补体C3a、IL-8及TNF-α含量相比均无统计学差异(P>0.05)。术后G1 IgG、IgM较术前降低(P<0.05),G2.3.4IgM较G1高且与G1有统计学差异(P<0.05)。术后G2.3.4补体C3a、IL-8、TNF-α较术前均升高(均为P<0.05),与G1有统计学差异(P<0.05)。G4与G2.3相比,术后G4补体C3a、TNF-α较早升高且升高明显,术后第14天G4补体C3a较G3高且与G3有统计学差异(P<0.05)。结论⑴自体输血患者较异体输血患者输血后抗感染免疫能力增强。⑵血液稀释和血液回收两种自体输血方式单独应用对机体抗感染免疫能力的影响没有差异。⑶血液稀释和血液回收两种方式联合应用有助于提高机体的抗感染免疫能力,较单独应用抗感染免疫能力增强。更多还原

【Abstract】 Objective To explore anti-infective immunological effects of different autologous transfusion after orthopaedic operations,and to further provide scientific theoretical proofs for reasonable using of blood during orthopaedic operations.Methods Under the prerequisite of kowning fact and consent of the patients,60 cases patients undertaken selective operation were choosed and divided into 4 groups at random with 15 for each group,all of which were in similar situation.The groups are ABT group(group1,G1),ANH group(group2,G2),IAT group(group3,G3),group of combind ANH and IAT (ANH+IAT)(group 4,G4).Taking groupⅠas the control, other three groups as experiment groups.The vein blood samples were taken before surgery and on the day 1,7 and 14 after surgery.The content of immunity globulin was measured by project immunity method,complement C3a and inflammation cytokine with radiation immunity method.Results Before induction of operation the IgG、IgM、C3a、IL-8 and TNF-αin each group were not significantly different from those in other groups(P>0.05). Comparing with those at base line,the IgG decreased significantly(p<0.05) in groupⅠafter operation.Comparing with those at base line,the IgM decreased significantly(p<0.05) in groupⅠafter operation;and were significantly different from groupⅡ、ⅢandⅣ(p<0.05). Comparing with those at base line,the C3a、IL-8、TNF-αincreased significantly(p<0.05)in groupⅡ、ⅢandⅣafter operation;and were significantly different from groupⅠ(p<0.05). Comparing with groupⅡ、Ⅲ, the C3a、TNF-αincreased earlier and higher in groupⅣ; Comparing with groupⅢ,the C3a increased significantly(p<0.05)in groupⅣ.Conclusion Comparing allogeneic transfusion with autologous transfusion,the latter enhance anti-infective immunopotency.There is not significantly different between ANH and IAT in immune function.The combined method of ANH and IAT is more useful for the promotion of anti-infective immunopotency.更多还原