自体血小板分离技术在全弓置换术中的初步应用

Primary application of autologous platelet-rich plasma during replacement of the ascending aorta and aortic arch

目的回顾性分析术前自体血小板分离技术在全弓置换术中对血液保护的作用。方法 2015年1月至6月共72例主动脉夹层(Stanford A),行全主动脉弓置换术,术中均使用血液回收技术。术前行自体血小板分离技术者为血小板分离组(n=28),未使用者为对照组(n=44)。手术均在深、中低温停循环和顺行脑灌注下完成。血小板分离组在深静脉置管后开始血小板分离,形成浓缩红细胞、血浆和富含血小板血浆三种成分。体外循环结束,鱼精蛋白中和肝素后开始回输三种成分。记录术前血小板分离的量,监测分离前后的激活凝血时间(ACT)数值,比较异体血制品的使用情况,观察患者术后24 h内胸液量、开胸止血率以及ICU停留时间等。结果两组年龄、体重、体外循环时间、阻断时间、停循环时间和最低温度之间没有显著差异。术前血小板分离组处理全血(1 704±244)ml,获得富含血小板血浆(225±51)ml、血浆(898±107)ml和红细胞(569±119)ml。分离后ACT数值延长(P<0.05)。体外循环结束后,术后24 h内胸液量和开胸止血率在两组间没有显著差异。但住院期间对照组使用血小板、血浆、冷沉淀的数量明显高于术前血小板分离组(P<0.05),ICU停留时间在两组间没有显著差异。结论全弓置换大血管手术前自体血小板分离技术可以减少围术期异体血制品的输注,提升血液保护效果。

Objective To evaluate the effect of autologous platelet-rich plasma （aPRP） transfusion as a blood conservation technique during aortic surgery. Methods Between January 2015 and June 2015, 72 patients who diagnosed with aortic dissection （Stanford A style） underwent ascending aorta and total aortic arch replacement using deep hypothermic circuit arrest （DHCA）. A group of 28 patients in which aPRP was used （aPRP group） were compared with the control group of 44 patients who didn＇t use aPRP. Collection of aPRP was performed after deep vein catheterization. Autologous blood was separated into t.hree ingredients including con- centrated red blood cells, plasma and aPRP before systemic infusion of heparin. After CPB and neutralization of protamine, three ingredients were transfused. Requirement of perioperative allogeneic transfusion and clinical outcomes including chest drainage and length of postoperative ICU stay were analyzed. Results There was no significant difference between the two groups in age, body weight, bypass time, cross-clamping time, and the lowest temperature. Perioperative allogeneic transfusions were fewer in the aPRP group compared with that of control group （ P 〈0.05）. However, there were no significant difference between the two groups in chest drainage and the length of postoperative ICU stay. Conclusion The utilization of aPRP is associated with reduction in allogeneic blood transfusion and hemostatic agent use during the ascending and totalarch replacement, which improve blood conservation.