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目的:观察非抗凝自体血回输对异位妊娠急诊手术患者血常规及免疫功能的影响。方法:选择行急诊手术异位妊娠伴腹腔内出血78例,在自体血回收过程中不加抗凝药,围术期持续监测心率(HR)、血压及血氧饱和度(SpO2)。在自体血回输前后,分别抽取静脉血检测血常规,同时测定红细胞C3b受体花环形成率(RBC-C3bRR)、红细胞免疫复合物花环形成率(RBC-ICR)、白细胞介素6(IL-6)和肿瘤坏死因子α(TNF-α)等免疫功能指标。记录术中回收血量及术后并发症。结果:(1)与自体血回输前及术前比较,回输后及术后24hHR显著下降(P<0.05);收缩压(SBP)、平均动脉压(MAP)及中心静脉压(CVP)显著升高(P<0.05)。与自体血回输前比较,回输后红细胞压积(Hct)、血红蛋白(Hb)显著升高(P<0.05),血小板(Plt)显著降低(P<0.05);RBC-C3bRR、RBC-ICR显著降低(P<0.05),IL-6、TNF-α显著升高(P<0.05)。(2)术中回收腹腔及术野积血(1153±436)ml/例,经洗涤后回输血量(867±264)ml/例;回输自体血后无一例出现蛋白尿、呼吸困难、血栓等严重并发症。结论:异位妊娠急诊手术患者行非抗凝自体血回输,可有效提高红细胞利用率,改善免疫功能,同时减少对凝血功能的影响。
Objective: To observe the effects of non-anticoagulated autologous blood transfusion on blood routine and immune function in emergency surgery of ectopic pregnancy. Methods: Seventy eight patients with ectopic pregnancy and intraperitoneal hemorrhage undergoing emergency operation were selected. No anticoagulant drugs were added during autologous blood collection. Heart rate (HR), blood pressure and blood oxygen saturation (SpO2) were continuously monitored during the perioperative period. Before and after autologous blood transfusion, venous blood was collected for blood routine examination. The rate of rosette C3b receptor (RBC-C3bRR), the rate of erythrocyte immune complex rosette formation (RBC-ICR), interleukin 6 (IL- 6) and tumor necrosis factor alpha (TNF-alpha) and other immune function indicators. Recorded the intraoperative recovery of blood volume and postoperative complications. Results: (1) The systolic blood pressure (SBP), mean arterial pressure (MAP) and central venous pressure (CVP) were decreased significantly (P <0.05) Significantly increased (P <0.05). Compared with those before autologous blood transfusion, hematocrit (Hct), hemoglobin (Hb) and platelet (Plt) were significantly decreased (P <0.05) after transfusion; RBC-C3bRR, RBC-ICR (P <0.05), IL-6 and TNF-α significantly increased (P <0.05). (2) intraoperative recovery of abdominal cavity and intraoperative hematoma (1153 ± 436) ml / case, washed back blood transfusion (867 ± 264) ml / case; no autologous blood after the return of proteinuria, dyspnea, Thrombosis and other serious complications. CONCLUSION: Non-anticoagulant autologous blood transfusion in patients undergoing elective emergency surgery can effectively improve the utilization of erythrocytes, improve immune function and reduce the influence on coagulation function.