| Objective: To evaluate the feasibility of intraoperation salvaged blood autotransfusion in posterior operation in patients of scoliosis. The second aim was to investigate the influence of perioperative allogeneic blood transfusion and intraoperation salvaged blood autotransfusion to the immune function of patients undergoing scoliosis orthoplasty by studying the changes of immunosuppressive acid protein (LAP) , soluble interlukin-2 receptor( (sIL-2R), interleukin-6 (IL-6) and subgroups of T lymphocytes.Methods: 1: 93 patients undergoing posterior approach scoliosis orthoplasty were randomly allocated to 2 groups: intraoperation salvaged blood autotransfusion group(48 cases) and allogeneic blood transfusion group (45 cases) . The perioperative counts of Hemoglobin (Hb), haematocrit (HCT) and platelet (PLT), and also the amount of blood savage blood or the allogenic blood transfusion of the 2 groups were recorded and compared. 2: Study of the influence on the immune functions of the patients undergoing intraoperation salvaged blood autotransfusion or allogeneic blood transfusion. Venous blood samples (10 ml) of the patients were extracted pre-operation and on the 1, 3, 5, 14d post-operation and anti-coagulated with heparin; plasm was prepared with centrifugation (2000r/min) and cryo-preserved (-20) for further detection.Flow cytometer assay was adopted to determine the level of Tlymphocytes subgroups; Immune Scattering Turbidimetry was conducted to detect immune globulin, complement C3, C, andCIC. The single radial immunodiffusion method and double antibody sandwich were used to pre-operation and post-operation detect the levels of serum sIL-2R, IL-6 and serum IAP. Enzyme-linked immuno-sorbent assay was performed to detect other relative indexes.Results: Compared with the allogenic blood transfusion group , the counts of stored blood transfusion decreased markedly in the intraoperation salvaged blood autotransfusion group, and the average levels of Hb, HCT , and PLT post-operation recovered to adjunct to the normal level on the whole. The counts of CD3 , CD4 and NK cell and CD4 +/ CD8 + in both groups decreased significantly after operation (P<0.05), and the decrease in the intraoperation salvaged blood autotransfusion group was comparatively milder and recovered basically on the 5 d post-operation. While the counts of T cell subsets , except for the CD8+, decreased markedly in allogenic blood transfusion group and kept in low level till 5d post-operation , suggesting the function of cellular immunity was greatly suppressed.The levels of serum IAP, sEL-2R and IL-6 in both groups elevated significantly after operation (P<0.01 or P<0.05). The elevation of IAP level was greater in allogenic blood transfusion group than blood savage group (P<0.05). The increase of IL-6 was more obvious while the sIL-2R level comparatively lower in blood savage group than in allogenic blood transfusion group , although the difference was of no statistically significance due to the small-scale sample.The IgM and CIC level post-operation in the allogenic blood transfusion group was significantly higher than that in blood savagegroup, suggesting a comparatively active humoral immunity in thisgroup.Conclusion: The intraoperation salvaged blood autotransfusion is a safeand effective method when clinically used in posterior operation in patientsof scoliosis. Compared with the allogenic blood transfusion, it can greatlydecrease the need of heterogonous blood, avoid the complications oftransfusion and effectively maintain the level of Hb, HCT and PLT.The operative strike contributes to the suppression of cellular immunity function in patients undergoing operation of scoliosis, and perioperative allogeneic blood transfusion makes the condition more severe. The intraoperation salvaged blood autotransfusion can alleviate the immune suppression and benefit to patients undergoing posterior operation in infection prevention. |
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