【罂粟摘要】输注储存的自体红细胞会导致肺动脉压升高
输注储存时间长的红细胞会增加死亡率。红细胞在储存过程中和输血后都会发生溶血。血浆血红蛋白清除的内源性一氧化氮，导致全身和肺血管收缩。
我们假设给志愿者输注储存40天的自体血液，由于增加了内皮细胞功能障碍(即内皮细胞一氧化氮分泌受损)，从而使志愿者的肺动脉压增加。我们还测试了在输血前和输血时吸入一氧化氮是否能防止肺动脉压升高。
14名患有内皮功能障碍的肥胖成年人参加了一项随机交叉研究，研究对象是输注储存3天或40天的自体去白细胞血液。志愿者分别输入了储存3天、40天血液，和在吸入80ppm一氧化氮的同时，输入储存40天的血液。
志愿者年龄为41±4岁(平均±4岁)，体重指数为33.4±1.3 kg/m2。血浆血红蛋白浓度在输注40天和吸入80ppm一氧化氮的同时，输入储存40天的自体去白细胞血液的这两组，血浆血红蛋白浓度均升高，但在输注储存3天自体去白细胞血液不升高。经胸超声心动图测得的平均肺动脉压在输注储存40d后升高(18±2至23±2 mmHg；P<0.05)，而输注储存3d后无明显变化(17±2至18±2 mmHg；P=0.5)。而吸入一氧化氮同时输注储存40d的志愿者肺动脉压降低(17±2至12±1 mmHg；P<0.05)。
输注储存40天的自体去白细胞血液与血浆血红蛋白水平和肺动脉压升高有关。吸入一氧化氮可以防止因输注储存的血液而引起的肺动脉压升高。
Autologous Transfusion of Stored Red Blood Cells Increases
Pulmonary Artery Pressure
Abstract
Rationale: Transfusion of erythrocytes stored for prolonged periods is associated with increased mortality. Erythrocytes undergo hemolysis during storage and after transfusion. Plasma hemoglobin scavenges endogenous nitric oxide leading to systemic and pulmonary vasoconstriction.
Objectives: We hypothesized that transfusion of autologous blood stored for 40 days would increase the pulmonary artery pressure in volunteers with endothelial dysfunction (impaired endothelial production of nitric oxide). We also tested whether breathing nitric oxide before and during transfusion could prevent the increase of pulmonary artery pressure.
Methods: Fourteen obese adults with endothelial dysfunction were enrolled in a randomized crossover study of transfusing autologous, leukoreduced blood stored for either 3 or 40 days. Volunteers were transfused with 3-day blood, 40-day blood, and 40-day blood while breathing 80 ppm nitric oxide.
Measurements and Main Results: The age of volunteers was 41±64 years (mean±SEM), and their body mass index was 33.4 ±1.3 kg/m2. Plasma hemoglobin concentrations increased after transfusion with 40-day and 40-day plus nitric oxide blood but not after transfusing 3-day blood. Mean pulmonary artery pressure, estimated by transthoracic echocardiography, increased after transfusing 40-day blood (18±2 to 23±2 mm Hg; P<0.05) but did not change after transfusing 3-day blood (17±2 to 18±2 mmHg; P=0.5). Breathing nitric oxide decreased pulmonary artery pressure in volunteers transfused with 40-day blood (17±2 to 12±1 mmHg; P<0.05). Conclusions:Transfusion of autologous leukoreduced blood stored for 40 days was associated with increased plasma hemoglobin levels and increased pulmonary artery pressure. Breathing nitric oxide prevents the increase of pulmonary artery pressure produced by transfusing stored blood.
翻译：安丽 编辑：佟睿 审校：曹莹
贵州医科大学 高鸿教授课题组