| 朱 魏,臧 婷,薄靳华,孙玉娥,张 伟.急性高容量血液稀释联合控制性低中心静脉压对脊柱后路手术患者炎症免疫调节及血液保护作用研究[J].,2024,(5):919-924 |
| 急性高容量血液稀释联合控制性低中心静脉压对脊柱后路手术患者炎症免疫调节及血液保护作用研究 |
| Study on the Effect of Acute Hypervolemic Hemodilution Combined with Control Low Central Venous Pressure on Inflammatory Immune Regulation and Blood Protection in Patients Undergoing Posterior Spinal Operation |
| 投稿时间：2023-09-28 修订日期：2023-10-23 |
| DOI：10.13241/j.cnki.pmb.2024.05.021 |
| 中文关键词: 脊柱后路手术 急性高容量血液稀释 控制性低中心静脉压 炎症反应 免疫功能 血流动力学 |
| 英文关键词: Posterior spinal operation Acute hypervolemic hemodilution Control low central venous pressure Inflammatory response Immune function Hemodynamics |
| 基金项目:国家自然科学基金项目（81701102） |
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| 中文摘要: |
| 摘要 目的：探讨急性高容量血液稀释（AHH）联合控制性低中心静脉压（CLCVP）对脊柱后路手术患者炎症、免疫调节、血液保护的作用。方法：选择2020年1月至2022年12月于南京鼓楼医院行脊柱后路手术的120例患者作为研究对象，根据随机数字表法分为对照组、AHH组、AHH+CLCVP组，每组各40例。对照组给予乳酸钠林格氏液血液稀释，AHH组给予AHH血液管理，AHH+ CLCVP组给予AHH联合CLCVP血液管理。比较三组围术期指标、血流动力学指标、炎症因子指标、免疫功能指标的变化情况。结果： AHH+CLCVP组术中出血量、悬浮红细胞输注量低于AHH组和对照组（P＜0.05），AHH组术中出血量、悬浮红细胞输注量低于对照组（P＜0.05）。与T1时间点相比，三组心率（HR）于手术开始后60 min（T2）~术毕（T3）先升高后降低（P＜0.05），平均动脉压（MAP）先降低后升高（P＜0.05），对照组和AHH组中心静脉压（CVP）于T2~T3先升高后降低（P＜0.05），AHH+CLCVP组T0~T3 CVP保持稳定水平（P＞0.05）。AHH+CLCVP组T2~T3 HR低于AHH组和对照组（P＜0.05），MAP高于AHH组和对照组（P＜0.05），CVP低于AHH组和对照组（P＜0.05），AHH组T2~T3 HR低于对照组（P＜0.05），MAP高于对照组（P＜0.05）。与T1时间相比，三组血清降钙素原（PCT）、C反应蛋白（CRP）、白细胞介素-6（IL-6）水平、外周血CD8+于T2~术后24 h（T4）先升高后降低（P＜0.05），外周血CD3+、CD4+、CD4+/CD8+于T2~T4先降低后升高（P＜0.05）。AHH+CLCVP组T2~T4血清PCT、CRP、IL-6水平、外周血CD8+低于AHH组和对照组（P＜0.05），外周血CD3+、CD4+、CD4+/CD8+高于AHH组和对照组（P＜0.05），AHH组T2~T4血清PCT、CRP、IL-6水平、外周血CD8+低于对照组（P＜0.05），外周血CD3+、CD4+、CD4+/CD8+高于对照组（P＜0.05）。结论：AHH联合CLCVP可稳定脊柱后路手术患者血流动力学，减少术中出血量和输血量，降低炎症反应，提高免疫功能。 |
| 英文摘要: |
| ABSTRACT Objective: To investigate the effects of acute hypervolemic hemodilution (AHH) combined with control low central venous pressure (CLCVP) on inflammation, immune regulation and blood protection in patients undergoing posterior spinal operation. Methods: 120 patients who were underwent posterior spinal operation in Nanjing Drum Tower Hospital from January 2020 to December 2022 were selected as the research objects, patients were divided into control group, AHH group and AHH+CLCVP group according to the random number table method, with 40 cases in each group. Control group was given lactated Ringer's solution hemodilution, AHH group was given AHH blood management, and AHH+CLCVP group was given AHH combine with CLCVP blood management. The changes of perioperative indexes, hemodynamic indexes, inflammatory factors indexes and immune function indexes were compared in three groups. Results: The intraoperative blood loss and suspended red blood cell transfusion volume in AHH+CLCVP group were lower than those in AHH group and control group (P<0.05), the intraoperative blood loss and suspended red blood cell transfusion volume in AHH group were lower than those in control group (P<0.05). Compared with T1 time point, the heart rate (HR) in three groups increased first and then decreased at 60 min after the start of operation (T2)~the end of operation (T3) (P<0.05), and the mean arterial pressure (MAP) decreased first and then increased (P<0.05), the central venous pressure (CVP) in control group and AHH group increased first and then decreased at T2~T3 (P<0.05), and the CVP in AHH+CLCVP group remained stable at T0~T3 (P>0.05). HR in AHH+CLCVP group was lower than that in AHH group and control group at T2~T3 (P<0.05), MAP was higher than that in AHH group and control group (P<0.05), CVP was lower than that in AHH group and control group (P<0.05), HR in AHH group was lower than that in control group at T2~T3 (P<0.05), MAP was higher than that in control group (P<0.05). Compared with T1 time, the levels of serum procalcitonin (PCT), C-reactive protein (CRP) and interleukin-6 (IL-6) in three groups, peripheral blood CD8+ increased first and then decreased at T2 ~24h after operation (T4) (P<0.05), peripheral blood CD3+, CD4+, CD4+/CD8+ decreased first and then increased at T2~T4 (P<0.05). The levels of serum PCT, CRP, IL-6 and peripheral blood CD8+ in AHH+CLCVP group were lower than those in AHH group and control group at T2~T4 (P<0.05), and the levels of peripheral blood CD3+, CD4+ and CD4+/CD8+ were higher than those in AHH group and control group (P<0.05), the levels of serum PCT, CRP, IL-6 and peripheral blood CD8+ in AHH group were lower than those in control group at T2~T4 (P<0.05), and the levels of peripheral blood CD3+, CD4+ and CD4+/CD8+ were higher than those incontrol group (P<0.05). Conclusion: AHH combined with CLCVP can stabilize hemodynamics, reduce intraoperative blood loss and blood transfusion, reduce inflammatory response and improve immune function in patients undergoing posterior spinal operation. |
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