目的：探讨围术期自体输血血液采集方法的改良。方法选取2012年12月至2013年12月湖北省中山医院手术用血患者130例，根据抽签法分为围术期自体输血组和预存式自体输血组，每组65例，围术期自体输血组开始手术时采用自体血液回收仪回收血液，预存式自体输血组在围术期自体输血组的基础上，令患者在择期手术前1个月开始采血，每3～5日1次，每次300～500 mL。记录两组的手术时间、术中输血量、异体输血量、输液量，术后止痛剂用量、肿瘤坏死因子α（ TNF－α）和补体 C3水平。结果围术期自体输血组异体输血量显著高于预存式自体输血组[（391±43） mL比（92±21） mL，P＜0．05]。与术前相比，预存式自体输血组术后血清 TNF－α水平[术前（1．19±0．25） mg／L，术后1 d（1．33±0．19） mg／L，术后7 d（1．52±0．21） mg／L]、补体 C3水平[术前（116±22） mg／L，术后1 d（120±18） mg／L，术后7 d（119±17） mg／L]表现出上升趋势（P＜0．05）。但围术期自体输血组手术前后的血清TNF－α水平[术前（1．19±0．22） mg／L，术后1 d （1．21±0．19） mg／L，术后7 d（1．18±0．18） mg／L ]、补体C3水平[术前（115±19） mg／L，术后1 d （132±15） mg／L，术后7 d（175±18） mg／L]比较差异无统计学意义（P＞0．05）。围术期自体输血组术后TNF－α水平、补体C3水平均显著低于预存式自体输血组（ P＜0．05）。结论改良自体输血能得到更多自体血液，能大量减少术中异体输血，提高术后TNFα和补体C3水平。%Objective To discuss the improvement of perioperative blood collection method for autolo-gous blood transfusion.Methods Total of 130 perioperative autologous blood transfusion patients in Zhongs-han Hospital of Hubei Province from Dec.2012 to Dec.2013 were divided into perioperative autotransfusion group and stored autotransfusion group according to the draw method,65 patients each.The perioperative au-totransfusion group started operation using autologous blood recovery device to salvage blood,while the stored autotransfusion group, on the basis of perioperative autotransfusion group′s plan, started from one month before the operation day,once every 3-5 day,300-500 mL blood was collected.The operation time,intraopera-tive blood transfusion amount,allogeneic blood transfusion amount,infusion volume,postoperative analgesic dosage,tumor necrosis factor α( TNF-α) and C3 levels of the two groups were recorded.Results The amount of allogeneic blood transfusion in perioperative autotransfusion group was significantly higher than that in the stored autotransfusion group [(391 ±43) mL vs (92 ±21) mL] (P<0.05).Compared with preop-eration,postoperative serum TNF-α[ before operation(1.19 ±0.25) mg/L,1 day after the operation(1.33 ± 0.19) mg/L,7 days after the operation (1.52 ±0.21) mg/L] and C3 levels[before operation(116 ± 22) mg/L,1 day after the operation(120 ±18) mg/L,7 days after the operation (119 ±17) mg/L] of the stored autotransfusion group rose(P<0.05).But no significant change was found before and after operation of serum TNF-αlevel[before operation(1.19 ±0.22) mg/L,1 day after the operation(1.21 ±0.19) mg/L, 7 days after the operation (1.18 ±0.18) mg/L ],C3 levels[before operation(115 ±19) mg/L,1 day after the operation(132 ±15) mg/L,7 days after the operation (175 ±18) mg/L] in perioperative autotransfu-sion group( P>0.05 ) .Postoperative TNF-αand C3 levels in the perioperative autotransfusion group were all significantly lower than the stored autotransfusiongroup ( P <0.05 ) .Conclusion Improved perioperative autologous blood transfusion is a good way to get more autologous blood,which can significantly reduce alloge-neic blood transfusion and raise the postoperative levels of TNF-α and C3.
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