急性血小板分离制备心脏手术患者富血小板血浆的质量分析

Qualitative Analysis of Platelet Rich Plasma Prepared by Acute Plateletapheresis in Patients Undergoing Heart Surgery

为评价心脏直视手术患者急性血小板分离制备的富血小板血浆(platelet-rich plasma,PRP)的效率和效果,对PRP质量进行了分析。20例ASAⅡ-Ⅲ级择期心脏手术患者在麻醉诱导后进行全血采集和血小板分离。分别测定分离前(T1)的全血,分离后(T2)的PRP和回输前(T3)的PRP中的血小板数(Plt)、血小板平均体积(MPV)、血小板分布宽度(PDW)、血浆内pH、血浆乳酸(LA)浓度和乳酸脱氢酶(LDH)浓度、细菌培养结果、血小板CD62p和PAC-1阳性率以及ADP激活后的CD62p和PAC-1阳性率。结果表明:与全血相比,分离后的PRP中的血小板计数为(783±184)×109/L,MPV、PDW和pH值显著降低(P<0.01),LA、LDH浓度及CD62p和PAC-1阳性率无明显变化;回输前PRP血小板计数为(765±167)×109/L,MPV、PDW和pH值与T1相比显著降低(P<0.01),而LDH浓度、CD62p和PAC-1阳性率与T1和T2比较显著增高(P<0.05或P<0.01);ADP激活后的CD62p和PAC-1阳性率各阶段无明显差异。结论:本研究所采取的方法可在术前高效分离心脏手术患者的血小板,而且不引起血小板活化;PRP在术中振荡保存后有部分血小板出现活化,但血小板整体活化功能无明显改变。

This study was aimed to evaluate the efficiency and effectiveness of platelet-rich plasma（PRP） prepared by acute plateletapheresis in patients undergoing open heart surgery, and to analyze the quality of prepared platelet-rich plasma. Whole blood from 20 patients with ASA Ⅱ - Ⅲwas collected and PRP was harvested by machine after induction of anesthesia. Platelet count （ Pit）, mean platelet volume （ MPV）, platelet distribution width （ PDW）, plasma pH, plasma lactic acid（LA） concentration, and lactic dehydrogenase （LDH） concentration, germiculture result, CD62p and PAC-1 positive rate of inactivated and activated platelets by ADP in the whole blood before plateletapheresis（ Tl ） , in the PRP after plateletapheresis （ T2 ） and PRP before back-transfusion （ T3 ） were determinated. The results showed that as compared with whole blood the platelet count in the PRP at T2 was （783 ± 184 ） × 109/L, MPV, PDW and pH significantly decreased （ P 〈 0. 01 ）, while the plasma LDH, LA concentration, CD62p and PAC-1 positive rate of inactivated platelets were not significantly different from the whole blood at T1. In the PRP at T3 , the platelet count, MPV, PDW and pH significantly decreased （P 〈 0.01 ）, while plasma LDH concentration, CD62p and PAC-1 positive rate of inactivated platelet significantly increased（ P 〈0.05 or P 〈0.01 ）compared with the whole blood at T1. There were no significant difference among the CD62p and PAC-1 positive rate of activated platelets in the whole blood and PRP. It is concluded that PRP can be effciently obtained from the patients undergoing open heart surgery by acute plateletapheresis, and the platelets in PRP are not activated during the preparing process. Some platelets in PRP are activated during the preserving process, but the whole activating function of platelets keeps normal.