自体输血与异体输血对创伤性颅脑损伤开颅手术患者凝血功能、细胞免疫功能和神经损伤标志物的影响

摘要 目的：探讨自体输血与异体输血对创伤性颅脑损伤（TBI）开颅手术患者凝血功能、细胞免疫功能和神经损伤标志物的影响。方法：回顾性分析2019年4月~2022年5月期间在本院行开颅手术的120例TBI患者的临床资料。根据输血方式的不同将患者分为异体输血组（n=58，异体输血）和自体输血组（n=62，自体输血），观察两组临床指标、细胞免疫功能、凝血功能、神经损伤标志物和不良反应发生率情况。结果：两组患者手术出血量、输血量、输注含凝血成分血制品比例对比，差异无统计学意义（P>0.05）。自体输血组出院时CD3⁺、CD4⁺、CD4⁺/CD8⁺高于异体输血组，CD8⁺低于异体输血组（P<0.05）。两组出院时凝血酶原时间（PT）、凝血酶时间（TT）、纤维蛋白原（FIB）、活化部分凝血活酶时间（APTT）组间对比无统计学差异（P>0.05）。自体输血组出院时S100钙结合蛋白B（S100B）、神经胶质原纤维酸性蛋白（GFAP）、神经元特异性烯醇化酶（NSE）低于异体输血组（P<0.05）。两组不良反应发生率组间比较无差异（P>0.05）。结论：自体输血用于TBI开颅手术患者，对患者的凝血功能影响较小，同时还可改善机体细胞免疫功能，降低神经损伤标志物水平。

Effects of Autotransfusion and Allogeneic Transfusion on Coagulation Function, Cellular Immune Function and Nerve Injury Markers in Patients with Traumatic Brain Injury Undergoing Craniotomy

ABSTRACT Objective: To investigate the effects of autotransfusion and allogeneic transfusion on coagulation function, cellular immune function and nerve injury markers in patients with traumatic brain injury (TBI) undergoing craniotomy. Methods: The clinical data of 120 patients with TBI who underwent craniotomy in our hospital from April 2019 to May 2022 were retrospectively analyzed. Patients were divided into allogeneic transfusion group (n=58, allogeneic transfusion) and autotransfusion group (n=62, autotransfusion) according to different blood transfusion methods. Clinical indexes, cellular immune function, coagulation function, nerve injury markers and incidence of adverse reactions in the two groups were observed. Results: There were no significant differences in operation bleeding volume, blood transfusion and proportion of blood products containing coagulation components in the two groups(P>0.05). CD3⁺, CD4⁺, CD4⁺/CD8⁺ in the autotransfusion group were higher than those in the allogeneic transfusion group at discharge, and CD8⁺ was lower than that in the allogeneic transfusion group (P<0.05). There were no significant differences in prothrombin time (PT), thrombin time (TT) and fibrinogen (FIB), activated partial thrombin time (APTT) in the two groups at discharge (P>0.05). The levels of S100 calc-binding protein B (S100B), glial fibrillary acid protein (GFAP) and neuron-specific enolase (NSE) in the autotransfusion group were lower than those in the allogeneic transfusion group at discharge(P<0.05). There was no difference in the incidence of adverse reactions between the two groups(P>0.05). Conclusion: Autotransfusion is used in patients with TBI undergoing craniotomy has little impact on the coagulation function of patients, and can also improve the cellular immune function of the body, and reduce the level of nerve injury markers.