【摘要】 目的　探讨异体输血和等容血液稀释自体输血对围术期T淋巴细胞亚群、NK细胞的变化。方法　选择直肠癌、结肠癌格或胃癌根治术病人 30例 ,随机均分为 2组。H组术中输异体全血 4 0 0ml;A组于手术切皮前放血 4 0 0ml,同时输入等量羟乙基淀粉 ,术中自体血回输给病人。分别于术前、输血前、术后第 1d、第 5d抽取静脉血 ,用流式细胞仪测定T细胞亚群和NK细胞的数量。结果　两组术后第 1dCD3 + 、CD4+ 、CD4+ /CD8+ 、NK细胞较术前显著减少 (P <0 0 5或 0 0 1) ,异体输血组较自体输血组减少更明显 (P <0 0 5 )。术后第 5d异体输血组CD3 + 、CD4+ 、CD4+ /CD8+ 、NK细胞仍较术前显著减少 ,自体输血组基本恢复正常。结论　围术期输异体血严重抑制病人免疫功能 ,等容血液稀释自体输血免疫抑制轻微 ,且术后免疫功能很快恢复。更多还原

【Abstract】 Objective To investigate the changes in natural kill cell and T lymphocyte subset counts after homologous and autologous blood transfusion Methods 30 ASA Ⅰ Ⅱ patients (20 male, 10 female) aged (49±16)yr, weighing (67±14)kg undergoing radical rectal, colon or stomach cancer surgery were randomly divided into two groups: group A received autologous blood transfusion and group H received homologous blood transfusion The patients′ preoperative Hb was >120g/L and hematocrit >0 35 The patients had no endocrine or immune disease and received neither radio , chemo nor hormone therapy Anesthesia was induced with propofol, midazolam, fentanyl and succinylcholine After tracheal intubation the patients were mechanically ventilated Anesthesia was maintained with enflurane inhalation and intermittent intravenous boluses of midazolam, fentanyl and vecuronium After operation the patients were transferred to recovery room and PCA was started when the patients were wide awake VAS was maintained at 2 4 Venous blood samples were taken before surgery, before blood transfusion and on the 1st and 5th postoperative day for determination of T lymphocyte subsets and natural kill cell counts by flow cytometry (EPICS Elite USA) Results The two groups were comparable regard to sex, types of operation, intraoperative blood loss and volume of fluid infused The mean duration of operation of the two groups was (196±42) min The NK cell and CD + 3 and CD + 4 counts and CD + 4/CD + 8 ratio before transfusion were not significantly different from those before operation in both groups The NK cell, CD + 3 and CD + 4 counts and CD + 4/CD + 8 ratio decreased significantly on the 1st postoperative day in both groups but the decrease was more pronounced in group H On the 5th postoperative day the NK cell, CD + 3, CD + 4 counts and CD + 4/CD + 8 ratio returned to preoperative level in group A but remained low in group H Couclusions Perioperative homologous blood transfusion has serious and prolonged inhibitory effects on patient′s immune function In autologous blood transfusion group the changes are milder and the recovery is more rapid as compared with those in group H更多还原