急性血小板分离对心脏直视手术患者血流动力学的影响

Haemodynamics effect of acute plateletpheresis in patients undergoing open heart surgery with cardiopulmonary bypass

目的评价急性血小板分离对心脏直视手术患者血流动力学的影响。方法选择拟择期在心肺转流(CPB)下行心脏直视手术患者30例,ASA分级Ⅱ或Ⅲ级。采用随机数字表法,将患者随机分为两组:对照组(C组,n=15)和急性血小板分离组(APP组,n=15)。APP组在麻醉诱导及中心静脉置管后行APP,提取富血小板血浆保存至CPB结束鱼精蛋白中和肝素后输入,C组不行APP。记录APP组中心静脉置管成功后(T1)、APP开始后5min(T2)、10min(T3)、15min(T4)、20min(T5)和APP结束(T6)的心率(HR)、平均动脉压(MAP)、中心静脉压(CVP)、心脏指数(CI)、每搏量指数(SVI)、全身血管阻力指数(SVRI)及每搏量变异度(SVV)等,C组在相应时间点记录上述血流动力学指标。结果与T1时比较,APP组T3～T6时CVP显著降低(P<0.05或0.01),T2～T6时SVV显著增高(P<0.01),其余指标差异无统计学意义;C组各项指标差异均无统计学意义。与C组比较,APP组T4～T6时CVP显著降低(P<0.01),T2～T6时SVV显著增高(P<0.01)。与C组比较,APP组患者去氧肾上腺素使用量和使用率显著增高(P<0.01)。结论 APP会减少心脏手术患者血容量,但并不明显减少患者心排血量,通过适当使用血管活性药,仍能保持血流动力学的稳定。

Objective To investigate the haemodynamics effect of acute plateletpheresis in patients undergoing open heart surgery with cardiopulmonary bypass(CPB).Methods Thirty patients undergoing elective cardiac surgery under CPB were randomly divided into 2 groups(n=15 each),control group(group C)and APP group.In the APP group,platelet-rich plasma was harvested immediately after general anesthesia induction and completed before pre-CPB heparinization and transfused to the patient after the completion of CPB and protamine neutralization of heparin.The group C was managed in the normal fashion without acute intraoperative pre-CPB plateletpheresis.HR,MAP,CVP,CI,SVI,SVRI and SVV were recorded after central venous catheter insertion(T1),5 min(T2),10 min(T3),15 min(T4),20 min(T5) after APP and the end of APP((T6).Results As compared with those at T1,CVP at T3-T6 were lower(P<0.05 or 0.01)and SVV at T2-T6 were higher(P<0.01)in the APP group.As compared with group C,CVP at T4-T6 were lower(P<0.01)and SVV at T2-T6 were higher(P<0.01),and more dose and ratio of phenylephrine used in the APP group(P<0.01).Conclusions Acute plateletpheresis induces the insufficient of blood volume in patients undergoing open heart surgery,but does not lower the cardiac output.The haemodynamics of patients can be stabilized by using some vasoactive drug.