摘要
目的探讨不同自体血回输量对脊柱手术患者术后凝血功能和炎症因子的影响。方法选择2023年1月至2024年3月于南京医科大学附属苏州医院接受脊柱手术,并且术中接受回收式自体输血的97例患者为研究对象。其中,男、女性患者分别为51、46例;年龄为(58.3±10.5)岁。根据术中自体血回输量,将这97例患者分为A组(n=24)、B组(n=23)、C组(n=25)、D组(n=25);自体血回输量分别为≤600、>600~900、>900~1200、>1200 mL。采用回顾性研究方法,分别收集手术切皮前(T1),自体血回输后2 h(T2),术后24 h(T3),术后48 h(T4)4个时间点,4组患者的血常规、凝血功能、炎症因子检测,以及动脉血血气分析结果。并且记录4组患者术后48 h异体输血量、输血反应及输血后并发症发生情况。4组定量资料总体比较采用单因素方差分析,两两比较采用LSD法;同组中4个时间点定量资料总体比较采用重复测量方差分析,两两比较采用配对t检验和Bonferroni校正;4组患者输血反应发生率总体比较采用Pearsonχ^(2)检验,两两比较采用χ^(2)检验和Bonferroni校正。4组患者性别构成比、年龄等一般临床资料分别比较,差异均无统计学意义(均为P>0.05)。本研究遵循的程序符合南京医科大学附属苏州医院人体试验委员会制定的标准,经过该伦理委员会批准(批准文号:K-2024-022-H01),并与所有患者签署临床研究知情同意书。结果①本研究4组患者T1时间点凝血功能指标、动脉血血气分析结果,以及炎症因子水平分别比较,差异均无统计学意义(均为P>0.05)。②T2~T4时间点,D组患者的活化部分凝血酶原时间(APTT)分别为(44.2±5.9)、(48.9±5.7)、(50.4±6.1)s,凝血酶原时间(PT)分别为(18.4±1.9)、(20.1±2.1)、(23.9±1.8)s,均分别高于A、B、C组;D组患者血小板计数(PLT)上述3个时间点分别为(135.4±50.7)、(124.5±48.3)、(121.9±47.5)×10^(9)/L,分别低于A、B、C组;并且差异均有统计学意义[总体比较:F=22.12、P<0.001,F=36.97、P<0.001,F=34.60、P<0.001(APTT);F=33.6、P<0.001,F=53.16、P<0.001,F=133.28、P<0.001(PT);F=3.08、P=0.032,F=5.12、P<0.001,F=6.23、P<0.001(PLT);两两比较均为P<0.001]。③T2~T4时间点,D组患者的血红蛋白(Hb)值分别为(95.2±8.9)、(92.7±9.8)、(93.7±8.3)g/L,血细胞比容(Hct)分别为(28.6±4.9)%、(26.1±5.9)%、(27.6±6.0)%;均分别低于A、B、C组,并且差异均有统计学意义[总体比较:F=25.71、56.42、85.53(Hb),8.01、23.36、27.55(Hct),均为P<0.001;两两比较均为P<0.001]。④T2~T4时间点,D组患者的肿瘤坏死因子(TNF)-α分别为(224.8±40.8)、(266.8±51.8)、(288.8±42.7)ng/mL,白细胞介素(IL)-6水平分别为(74.6±7.0)、(134.2±7.9)、(156.3±6.4)ng/mL,均分别高于A、B、C组;而D组的IL-10水平上述3个时间点分别为(20.4±7.2)、(22.7±7.9)、(24.3±9.2)ng/mL,分别低于A、B、C组;并且差异均有统计学意义[总体比较:F=6.30、5.44、13.29(TNF-α),34.34、87.42、79.14(IL-6),33.29、47.20、39.22(IL-10),均为P<0.001;两两比较均为P<0.05]。⑤D组患者的术后48 h异体红细胞、新鲜冰冻血浆(FFP)输注量,以及伤口引流量分别为(3.7±0.8)U、(308.7±66.9)mL、(418.7±66.9)mL,均分别高于A、B、C组,并且差异均有统计学意义(总体比较:F=24.90、28.14、21.57,均为P<0.001;两两比较均为P<0.05)。C组患者的伤口引流量为(382.6±61.7)mL,均分别高于A、B组,并且差异均有统计学意义(均为P<0.001)。⑥4组患者术后48 h输血反应发生率分别为8.3%(2/24)、13.0%(3/23)、16.0%(4/25)、44.0%(11/25),其中D组输血反应发生率最高,并且差异均有统计学意义(4组总体比较:χ^(2)=11.70,P=0.009;D组分别比A、B、C组:χ^(2)=7.99,P=0.005;χ^(2)=5.56,P=0.019;χ^(2)=4.67,P=0.031)。⑦4组患者术后48 h输血并发症发生率分别为8.3%(2/24)、8.7%(2/23)、12.0%(3/25)、36.0%(9/25),其中D组患者术后并发症发生率最高,并且差异均有统计学意义(4组总体比较:χ^(2)=9.46,P=0.024;D组分别比A、B、C组:χ^(2)=5.38,P=0.021;χ^(2)=5.06,P=0.024;χ^(2)=3.95,P=0.046)。结论自体血回输量≤900 mL时,对患者术后凝血功能及伤口引流量没有影响,是一种安全、可靠的血液保护技术,能有效降低术后炎症反应,减少异体输血反应。当自体血回输量>1200 mL时,对患者术后凝血功能有影响且术后并发症较多。
Objective To explore the effects of different autologous transfusion volumes on postoperative coagulation function and inflammatory factors in patients undergoing spinal surgery.Methods From January 2023 to March 2024,a total of 97 patients who underwent spinal surgery and received salvage autologous transfusion during surgery at Suzhou Hospital Affiliated to Nanjing Medical University were selected as the research subjects.Among them,there were 51 males and 46 females,with an age of(58.3±10.5)years.According to the intraoperative autologous transfusion volumes,the 97 patients were divided into group A(n=24),group B(n=23),group C(n=25),and group D(n=25);their blood volumes of autologous transfusion were≤600,>600-900,>900-1200,and>1200 mL,respectively.A retrospective study method was used to collect the results of blood routine,coagulation function,inflammatory factor detection,and blood gas analysis of the 4 groups of patients at 4 time points as before skin incision(T1),2 h after autologous transfusion(T2),24 h after surgery(T3),and 48 h after surgery(T4).The allogeneic transfusion volumes,the incidence rates of transfusion reactions and postoperative complications were recorded in each group.The overall comparison of measurement data among the 4 groups was performed with one-way analysis of variance,and the pairwise comparison was performed with the LSD method;the measurement data at the 4 different time points in one same group were compared with repeated measures analysis of variance,and the pairwise comparison was performed with paired t-test and Bonferroni correction;the overall comparison of the incidence of transfusion reactions among 4 groups was performed with the Pearson Chi-square test,and the pairwise comparison was performed with the Chi-square test and Bonferroni correction.There were no significant differences in the gender composition,age and other general clinical data among the 4 groups(all P>0.05).The procedures followed in this study were in accordance with the standards set by the Human Experimentation Committee of Suzhou Hospital Affiliated to Nanjing Medical University and were approved by the Ethics Committee(Approval No.K-2024-022-H01),and all patients signed informed consents for clinical research.Results ①In this study,there were no significant differences in the coagulation function indices,blood gas analysis results,and inflammatory factor levels among the 4 groups of patients at T1 time point(all P>0.05).②At T2-T4 time points,the activated partial prothrombin time(APTT)of patients in group D were(44.2±5.9),(48.9±5.7),and(50.4±6.1)s,and the prothrombin time(PT)were(18.4±1.9),(20.1±2.1),and(23.9±1.8)s respectively,which were higher than those of groups A,B,and C,respectively.The platelet count(PLT)of patients in group D at T_(2)-T_(4) time points were(135.4±50.7),(124.5±48.3),and(121.9±47.5)×10^(9)/L,respectively,which were lower than those of groups A,B,and C,respectively.All the differences were statistically significant[overall comparison:F=22.12,P<0.001;F=36.97,P<0.001;F=34.60,P<0.001(APTT).F=33.6,P<0.001;F=53.16,P<0.001;F=133.28,P<0.001(PT).F=3.08,P=0.032;F=5.12,P<0.001;F=6.23,P<0.001(PLT).Pairwise comparisons were all P<0.001].③At T2-T4 time points,the hemoglobin(Hb)values of patients in group D were(95.2±8.9),(92.7±9.8),and(93.7±8.3)g/L;and the hematocrit(Hct)values were(28.6±4.9)%,(26.1±5.9)%,and(27.6±6.0)%,respectively;all of which were lower than those of group A,B,and C,respectively,and the differences were statistically significant[overall comparison:F=25.71,56.42,85.53(Hb);8.01,23.36,27.55(Hct);all P<0.001.Pairwise comparisons were all P<0.001].④At T2-T4 time points,the tumor necrosis factor(TNF)-αlevels of patients in group D were(224.8±40.8),(266.8±51.8),and(288.8±42.7)ng/mL,and interleukin(IL)-6 levels were(74.6±7.0),(134.2±7.9),and(156.3±6.4)ng/mL,which were higher than those in groups A,B,and C;while the IL-10 levels were(20.4±7.2),(22.7±7.9),and(24.3±9.2)ng/mL,respectively,which were lower than those in groups A,B,and C,respectively;and the differences were statistically significant[overall comparison:F=6.3,5.44,13.29(TNF-α);34.34,87.42,79.14(IL-6);33.29,47.20,39.22(IL-10);all P<0.001.Pairwise comparisons were all P<0.05].⑤The allogeneic transfusion volumes,fresh frozen plasma(FFP)volumes,and wound drainage volumes in group D of patients 48 h after surgery were(3.7±0.8)U,(308.7±66.9)mL,and(418.7±66.9)mL,respectively,which were all higher than those in groups A,B,and C,respectively,and the differences were statistically significant(overall comparison:F=24.90,28.14,21.57;all P<0.001.Pairwise comparisons were all P<0.05).The wound drainage volume of group C was(382.6±61.7)mL,which was higher than that of groups A and B,respectively,and the differences were statistically significant(all P<0.001).⑥The incidence rates of transfusion reactions 48 h after surgery in the 4 groups were 8.3%(2/24),13.0%(3/23),16.0%(4/25),and 44.0%(11/25),respectively.The incidence rate of transfusion reactions was highest in group D,and the difference was statistically significant(overall comparison:χ^(2)=11.70,P=0.009;group D vs groups A,B,and C:χ^(2)=7.99,P=0.005;χ^(2)=5.56,P=0.019;χ^(2)=4.67,P=0.031,respectively).⑦The incidence of blood transfusion complications 48 h after surgery in the 4 groups were 8.3%(2/24),8.7%(2/23),12.0%(3/25),and 36.0%(9/25),respectively.The incidence of postoperative complications was highest in group D,and the differences were statistically significant(overall comparison:χ^(2)=9.46,P=0.024;group D vs groups A,B,and C:χ^(2)=5.38,P=0.021;χ^(2)=5.06,P=0.024;χ^(2)=3.95,P=0.046,respectively).Conclusions Autologous transfusion volume≤900 mL has no effect on the patients′postoperative coagulation function and wound drainage volume.It is a safe and reliable blood protection technology that can effectively reduce postoperative inflammatory response and reduce allogeneic transfusion reactions.When the autologous transfusion volume is>1200 mL,it will affect the patients′postoperative coagulation function and cause more postoperative complications.
作者
韩丽
杨芬
袁晨
赵月
赵李红
杨昌建
谢阳
Han Li;Yang Fen;Yuan Chen;Zhao Yue;Zhao Lihong;Yang Changjian;Xie Yang(Department of Anesthesiology,Affiliated Suzhou Hospital of Nanjing Medical University,Suzhou Municipal Hospital,Gusu School of Nanjing Medical University,Suzhou 215002,Jiangsu Province,China)
出处
《国际输血及血液学杂志》
2025年第2期150-160,共11页
International Journal of Blood Transfusion and Hematology
关键词
输血
自体
输血反应
脊柱手术
凝血功能
炎症反应
Blood transfusion,autologous
Transfusion reaction
Spinal surgery
Coagulation function
Inflammatory response
