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探讨自体富血小板血浆分离回输在A型主动脉夹层手术中的血液保护作用 被引量:12

The Blood-saving Effect of Autologous Platelet-rich Plasma Back-transfusion in Patients With Stanford Type A Aortic Dissection Surgery
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摘要 目的:探讨术前自体富血小板血浆(PRP)分离回输在A型主动脉夹层手术中的血液保护作用。方法:连续入选2013-01至2015-10期间择期手术的A型主动脉夹层患者59例,平均年龄(50±6)岁,平均体重(80±12)kg。59例患者随机分为两组:传统组(n=31)和自体富血小板血浆分离回输组(回输组,n=28)。分别在麻醉诱导前、心肺转流(CPB)开始前、CPB结束前、术后1 h、24 h、48 h测定血红蛋白(Hb)水平、血小板计数、凝血酶原时间(PT)和活化部分凝血酶时间(APTT)。记录术中和术后48 h异体输血情况和术后48 h引流量。记录围术期并发症发生情况。结果:回输组PRP分离处理的全血容量(1269±197)ml,PRP容量(753±78)ml,PRP分离时间(35±9)min,分离血小板数量占全身总数的(22±3)%。与传统组比较,回输组血红蛋白水平CPB开始前明显降低[(131.0±15.0)g/L vs(101.0±10.0)g/L,P〈0.05],血小板计数在CPB结束前明显减少[(115.0±51.0)×10~9/L vs(83.0±23.0)×10~9/L,P〈0.05],在术后1 h、24 h、48 h明显增加[(103.0±25.0)×10~9/L vs(151.0±27.0)×10~9/L、(105.0±25.0)×10~9/L vs(147.0±39.0)×10~9/L、(101.0±26.0)×10~9/L vs(149.0±35.0)×10~9/L,P均〈0.05],PT和APTT在术后1 h、24h明显缩短[(17.6±2.1)s vs(14.1±1.1)s、(17.6±2.7)s vs(13.5±0.8)s,P均〈0.05]。回输组术中血小板、血浆和冷沉淀输入量和术后红细胞、血小板、血浆和冷沉淀输入量及术后48 h引流量显著少于传统组(P〈0.05)。与传统组比较,回输组术后急性肺损伤明显减少(32.1%vs19.4%,P〈0.05),机械通气时间和重症监护病房(ICU)停留时间明显缩短[(69.1±5.9)h vs(43.1±1.5)h、(8.1±2.8)d vs(5.3±1.1)d,P〈0.05]。结论:术前自体富血小板血浆分离回输能显著减少A型主动脉夹层术后出血量和异体输血量,具有明显的血液保护作用。 Objective: To explore the blood-saving effect of autologous platelet-rich plasma(PRP) back-transfusion in patients with Stanford type A aortic dissection surgery. Methods: A total of 59 consecutive patients who received Stanford type A aortic dissection surgery in our hospital from 2013-01 to 2015-10 were studied. The patients were at the age of(50±6) years with mean body weighting at(80±12) kg and were randomly divided into 2 groups: Traditional(T) group,n=31 and Autologous PRP back-transfusion(P) group,n=28. Blood levels of Hb,platelet counts,PT,APTT were measured at pre-induction of anesthesia(T1),before CPB(T2),prior finishing of CPB(T3) and at 1 h(T4),24 h(T5),48 h(T6) after the operation. The in-operative,48 h post-operative volumes of allogeneic blood transfusion and the volume of chest tube drainage at 48 h after operation were recorded; the complication occurrence at peri-operative period was recorded. Results: In P group,whole blood processing volume was(1269±197) ml,PRP volume was(753±78) ml,PRP separation time was(35±9) min and the separated platelets were about(22±3)% of total platelet counts. Compared with T group,P group had decreased Hb at T2(131.0±15.0) g/L vs(101.0±10.0) g/L,decreased platelet counts at T3(115.0±51.0)×10~9 /L vs(83.0±23.0)×10~9/L,while increased platelet counts at T4(103.0±25.0)×10~9/L vs(151.0±27.0)×10~9/L,T5(105.0±25.0)×10~9 /L vs(147.0±39.0)×10~9/L and T6(101.0±26.0) ×10~9/L vs(149.0±35.0)×10~9/L,all P0.05; P group presented reduced PT at T4(17.6±2.1) s vs(14.1±1.1) s and T5(17.6±2.7) s vs(13.5±0.8) s,all P0.05. The in-operative transfusions of platelet,plasma,cold precipitation and post-operative transfusions of red blood cells,platelets,plasma,cold precipitation and the volume of chest tube drainage at 48 h after operation were less in P group,P0.05. Compared with T group,P group had the lower rates of acute post-operative lung injury(32.1% vs 19.4%),shorter mechanical ventilation time(69.1±5.9) h vs(43.1±1.5) h and ICU staying time(8.1±2.8) d vs(5.3±1.1) d,all P0.05. Conclusion: Autologous PRP back-transfusion could reduce the post-operative bleeding and allogeneic blood transfusion for Stanford A aortic dissection surgery,it has obvious blood-saving effect.
出处 《中国循环杂志》 CSCD 北大核心 2016年第4期389-392,共4页 Chinese Circulation Journal
基金 河南省农村和城市急性ST段抬高型心肌梗死救治现状和防治策略研究(132102310080)
关键词 主动脉瘤 自体富血小板血浆 心肺转流 血液保护 Aortic aneurysm Autologous platelet-rich plasma Cardiopulmonary bypass Blood-saving
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