ABSTRACT
Objective To compare the effects of allogeneic blood transfusion and hemodiluted autotransfusion on cellular immune function in the patients undergoing cesarean section.Methods Sixty patients,aged 20-35 yr,weighing 50-80 kg,of American Society of Anesthesiologists physical status Ⅰ or Ⅱ,scheduled for elective cesarean section,were randomly divided into 2 groups (n =30 each) using a random number table:hemodiluted autotransfusion group (group HAT) and allogeneic blood transfusion group (group ABT).Both groups received epidural anesthesia.The radial artery was cannulated after epidural anesthesia,and the autologous blood was collected in group HAT.The autologous blood transfusion timing:intraoperative blood loss was expected to exceed 20％ of blood volume.For the patients in whom intraoperative blood loss was not expected to exceed 20％ of blood volume,bleeding was stopped,and autologous blood was infused intravenously after peritoneum closure.The allogeneic blood transfusion timing:when hemoglobin ＜ 70 g/L,packed red blood cells 1-5 U were infused intravenously;when prothrombin time,or activated partial thromboplastin time ＞ 1.5 times of the normal value,the fresh frozen plasma 100-400 ml was infused intravenously;when platelet count＜50× 109/L,platelets 10-40 U were infused intravenously.When entering the operating room (T0),on 1st day after operation (T1),and on 5th day after operation (T2),blood samples were collected to detect the levels of T lymphocyte subsets CD3+,CD4+ and CD8+ (using FACScan flow cytometer),and serum interleukin-2 (IL-2) and IL-6 concentrations (by enzyme-linked immunosorbent assay).CD4+/CD8+ ratio was calculated.Results Compared with the values at T0,the levels of CD3+ and CD4+,CD4+/CD8+ ratio,and serum IL-2 concentrations were significantly decreased,and the serum IL-6 concentrations were increased at T1,2 in group ABT,and at T1 in group HAT (P＜0.05).Compared with group ABT,the CD3+ and CD4+ levels,CD4+/CD8+ ratio and serum IL-6 concentrations were significantly increased at T1,and the serum IL-2 concentrations were increased at T1,2 in group HAT (P＜0.05).Conclusion Compared with allogeneic transfusion,hemodiluted autotransfusion has less inhibitory effect on cellular immune function in the patients undergoing cesarean section.
ABSTRACT
Objective To investigate the effect of acute normovolemic hemodilution on immune function by observing the level change of lymphocyte subsets in maternity sera.Methods 60 ASA I ～ Ⅱ parturients were divided into 2 groups,30 cases in each group.Parturients of group A received acute normovolemic hemodilution and parturients of group C received allogeneic blood transfusion.Blood pressure,heart rate,duration of the cesarean section and blood loss were observed.2mL blood samples were taken from the mothers'vein before the surgery,1 day after the surgery,5 days after the surgery.Flow cytometry was used to measure T lymphocyte subsets.Results The levels of CD3+,CD4+,CD8+,CD4+/CDs+ before the surgery had no statistically significant differences between two groups (P ＞ 0.05).The levels of CD3+ [(52.35 ±5.62)％,(48.44±6.45)％],CD4+ [(36.90±7.93)％,(32.05 ± 8.94)％],CD4+/CD8+ [(1.15 ± 0.26),(0.97 ± 0.22)] were much lower 1 day after the surgery than those of preoperation [CD3+:(59.67 ± 3.45) ％,(60.58 ± 4.27) ％ ; CD4+:(43.71 ± 8.45) ％,(43.21 ± 8.45) ％ ; CD4+/CDs+:(1.41 ±0.38),(1.45 ±0.48)] in both two groups(t =6.10,2.50;3.22,4.97;3.09,4.98;P ＜0.05).In group A,the levels of CD3+,CD4+,CD4+/CD8+ [(58.78 ± 5.24) ％,(43.18 ± 8.48) ％,(1.41 ± 0.41)] had no statistical differences 5 days after the surgery(P ＞ 0.05) compared with those of preoperation.While in group C,the levels of CD3+ [(57.11 ± 6.81) ％],CD4+ [(38.68 ± 7.70) ％],CD4+/CDs+ [(1.19 ± 0.37)] were lower than the levels before the surgery[(60.58 ± 4.27) ％,(43.21 ± 8.45) ％,(1.45 ± 0.48)],and of the differences were statistically significant (t =2.46,2.17,2.35 ;P ＜ 0.05).Conclusion Compared with allegeic transfusion,acute normovolemic hemodilution could benefit the recovery of parturients by alleviate the inhibitory effect of transfusion on the immune function.