范振海 冯源 谢铭 王家辉 章涛 王钰莹 余丽梅

[摘要] 目的 觀察两种干预措施在外周血血细胞采集期间低钙血症反应的发生情况，为有效预防和纠正枸橼酸葡萄糖（acid-citrat dextrose，ACD）不良反应提供依据； 方法 使用COM.TEC血细胞分离机进行外周血血细胞采集。整群选取遵义医学院附属医院胃肠外科和腹部肿瘤内科2014年1—12月期间收治的109例结直肠癌患者随机分为两组，观察组50例，对照组59例。分别在不同时机调整ACD与全血比例的采集参数，观察与分析低血钙反应的发生情况。结果 对照组59例患者中39例（66.1%）出现不同程度的低钙血症表现，其中33例需再次或多次静脉推注葡萄糖酸钙注射液后方能缓解，而观察组仅有11例出现了低钙血症，不良反应发生率为22.0%， 8例需再次静脉推注葡萄糖酸钙后症状缓解，与对照组相比，低血钙不良反应发生率显著降低（P<0.01）。结论 在外周血血细胞采集过程中，适当时机下调ACD与全血比例，可有效降低ACD中毒引起的低血钙反应。

[关键词] 结直肠癌；血细胞采集；枸橼酸；低钙血反应

[中图分类号] R735 [文献标识码] A [文章编号] 1674-0742（2018）01（a）-0016-04

Prevention of Hypocalcemia in Collected Blood of Peripheral Blood Colorectal Cancer Patients

FAN Zhen-hai1， FENG Yuan1， XIE Ming2， WANG Jia-hui1，3， ZHANG Tao1， WANG Yu-ying1， YU Li-mei1

1.Key Laboratory of Cell Engineering in Guizhou Province， the Affiliated Hospital of Zunyi Medical University， Zunyi，Guizhou Province， 563003 China； 2.Department of Gastrointestinal Surgery， the Affiliated Hospital of Zunyi Medical University， Zunyi， Guizhou Province， 563003 China； 3.Department of Abdominal Oncology， the Affiliated Hospital of Zunyi Medical University， Zunyi， Guizhou Province， 563003 China

[Abstract] Objective This paper tries to observe the occurrence of hypocalcemia during the peripheral blood cell collection by two kinds of interventions and to provide basis for the effective prevention and correction of the toxic reaction of acid-citrate dextrose （ACD）. Methods Peripheral blood cells were collected using a COM.TEC blood cell separator. Group selection 109 patients with colorectal cancer who were admitted to the Department of Gastrointestinal Surgery and Abdominal Oncology， Affiliated Hospital of Zunyi Medical College from January to December 2014 were randomly divided into two groups： observation group （50 cases） and control group （59 cases）. The parameters of ACD and whole blood were adjusted at different timings and the occurrence of hypocalcemia were observed and analyzed. Results In control group， 39 out of 59 patients （66.1%） showed a different degree of hypocalcemia reactions， especially it was worth attention 33 of these patients required repeated or multiple intravenous calcium gluconate injection to relief symptoms. But the incidence of hypocalcemia reactions was 11 out of 50 patients （22.0%） in observation group， only 8 patients needed repeated or multiple intravenous calcium gluconate injection to relief symptoms. Compared with control group， the incidence of hypocalcemia reactionss significantly decreased in observation group （P<0.01）. Conclusion In peripheral blood cell collection process， the appropriate time to reduce the proportion of ACD and whole blood can effectively reduce hypocalcemia caused by ACD poisoning reaction.

[Key words] Colorectal cancer； Blood cell collection； Acid-citrate dextrose； Hypocalcemia reactions

通过血细胞分离机对所需的外周血血细胞成分进行体外富集是临床一种常用的操作方法，由于其采集方便，无需住院、麻醉，且合并症少，供者易接受，目前已在造血干细胞移植和肿瘤的免疫细胞治疗中得到广泛应用。与肝素抗凝不同，枸橼酸盐具有抗凝作用较为持久，对体内凝血级联反应影响较小，不增加出血风险等优点，已成为体内外常用的抗凝药物[1-3]。然而在血细胞采集过程中，低钙血症是枸橼酸盐应用所引起的最为常见的不良反应，若不注意预防、及时发现和处理，不但影响采集效果，可能使采集中断，严重者威胁患者生命。……