摘要
目的探究贮存式自体输血(preoperative autologous blood donation,PABD)适宜贮血时间,为保障自体血应用的安全性及有效性提供理论依据。方法选取具有PABD适应证的骨科手术患者10例,根据体重计算总血容量,术前1周采集10%总血容量的自体血,于采血前、采血毕检测患者血常规及血流动力学变化;留存50 ml自体血制备成RBC悬液用于研究,分别于1、7、14、21、28 d时测定贮存自体血的有效携氧量(Q)、氧亲和力(P_(50))、ATP、2,3‑二磷酸甘油酸(2,3‑diphosphoglycerate,2,3‑DPG)、Na^(+)‑K^(+)‑ATP酶、Ca2^(+)‑Mg2^(+)‑ATP酶、活性氧(reactive oxygen species,ROS),并分析其相关性。结果与采血前比较,采血毕患者体内RBC计数、Hb、Hct、RBC聚集指数、RBC刚性指数下降(P<0.05)。与贮存1 d比较,RBC Q值、Na^(+)‑K^(+)‑ATP酶活性、Ca2^(+)‑Mg2^(+)‑ATP酶活性在贮存7、14、21、28 d时降低,ATP、2,3‑DPG含量在贮存14、21、28 d时降低,P_(50)值在贮存21、28 d时降低,ROS含量在贮存7、14、21、28 d时升高(P<0.05);与贮存7 d比较,RBC Q值、2,3‑DPG含量、Na^(+)‑K^(+)‑ATP酶活性在贮存14、21、28 d时降低,P_(50)值、ATP、Ca2^(+)‑Mg2^(+)‑ATP酶活性在贮存21、28 d时降低,ROS含量在贮存14、21、28 d时升高(P<0.05)。RBC ROS含量与贮存时间呈正相关(P<0.05);RBC Q值、P_(50)、ATP、2,3‑DPG、Na^(+)‑K^(+)‑ATP酶、Ca2^(+)‑Mg2^(+)‑ATP酶含量与贮存时间、RBC ROS含量呈负相关(P<0.05)。结论PABD RBC贮存14 d内可基本保持携氧能力的正常,随着体外贮存时间的增加,RBC携氧能力相应降低,可能与RBC氧化应激损伤有关。
Objective To explore the suitable blood storage time of preoperative autologous blood donation(PABD)so as to provide theoretical basis for ensuring the safety and effectiveness of autologous blood application.Methods Ten patients undergoing orthopedic surgery with PABD indications were selected,and the total blood volume was calculated according to the patient's weight.The autologous blood accounting for 10% of the total blood volume was collected one week before operation.The blood routine and hemodynamics were detected before and after blood collection,and 50 ml autologous blood was reserved to prepare red blood cell(RBC)suspension for research use.The effective oxygen‑carrying amount(Q),oxygen affinity(P_(50)),adenosine triphosphate(ATP),2,3‑diphosphoglycerate(2,3‑DPG),Na^(+)‑K^(+)‑ATPase,Ca2^(+)‑Mg2^(+)‑ATPase,reactive oxygen species(ROS)of the stored autologous blood samples were measured on days 1,7,14,21 and 28 and their correlations were analyzed.Results Compared with those before blood collection,the RBC count,hemoglobin(Hb),hematocrit(Hct),RBC aggregation index and RBC rigidity index decreased after blood collection(P<0.05).Compared with storage for one day,RBC Q value,Na^(+)‑K^(+)‑ATPase activity and Ca2^(+)‑Mg2^(+)‑ATPase activity decreased on days 7,14,21 and 28,ATP and 2,3‑DPG content decreased on days 14,21 and 28,P_(50) value decreased on days 21 and 28,and ROS content increased on days 7,14,21 and 28(P<0.05).Compared with storage for seven days,RBC Q value,2,3‑DPG content and Na^(+)‑K^(+)‑ATPase activity decreased at days 14,21 and 28,while P_(50) value,ATP and Ca2^(+)‑Mg2^(+)‑ATPase activity decreased on days 21 and 28,and ROS content increased on days 14,21 and 28(P<0.05).The ROS content of RBC was positively correlated with storage time(P<0.05);RBC Q value,P_(50),ATP,2,3‑DPG,Na^(+)‑K^(+)‑ATP ase and Ca2^(+)‑Mg2^(+)‑ATPase contents were negatively correlated with storage time and RBC ROS content(P<0.05).Conclusions PABD RBC can basically maintain normal oxygen‑carrying capacity within 14 days,and the oxygen‑carrying capacity of RBC decreases with the prolonging of storage time,which may be related to the oxidative stress injury of RBC.
作者
张紫薇
周晓芳
王欢
汪晓晓
郭建荣
Zhang Ziwei;Zhou Xiaofang;Wang Huan;Wang Xiaoxiao;Guo Jianrong(Graduate College,Wannan Medical College,Wuhu 241002,China;Department of Anesthesiology,Shanghai Gongli Hospital,the Na-val Military Medical University,Shanghai 200135,China)
出处
《国际麻醉学与复苏杂志》
CAS
2021年第6期572-577,共6页
International Journal of Anesthesiology and Resuscitation
基金
上海市浦东新区卫生系统重点学科群建设项目(PWZxq2017-10)
上海市卫生健康委员会科研项目(202040474)。
关键词
贮存式自体输血
贮存时间
红细胞
携氧能力
氧化损伤
Preoperative autologous blood donation
Storage time
Red blood cell
Oxygen carrying capacity
Oxidative damage
