急性血小板分离或自体血回输对体外循环冠状动脉旁路移植术患者血液保护的影响

Blood-saving effects of acute plateletpheresis and autologous blood transfusion in patients undergoing coronary artery bypass grafting by CPB

目的：比较急性血小板（Plt）分离与自体血回输对体外循环（CPB）冠状动脉旁路移植术（CABG）患者的血液保护效果。 方法：择期拟在CPB下CABG 患者60例，ASA分级Ⅱ级或Ⅲ级，年龄40～65岁，体质量70～103 kg。采用随机数字表法，将患者随机分为3组（n=20）：对照组（C组）、自体血回输组（Z组）和急性Plt分离组（APP组）。APP组在麻醉诱导后行APP，提取富Plt血浆，于CPB结束鱼精蛋白中和肝素后10 min回输，Z组在麻醉诱导后行自体血放血入枸橼酸保存液血袋，回输同APP组，C组不作处理。于麻醉诱导后5 min（T1）、鱼精蛋白中和肝素后10 min（T2）和术后即刻（T3），采集中心静脉血样，检测血常规和Sonoclot凝血及血小板功能，记录Hb、Plt、凝血速率（CR）及血小板功能（PF）。记录CPB时间、主动脉阻断时间、关胸时间、术后引流量和输血情况。结果：与C组比较，Z组和APP组T3时Plt、CR升高，APP组T3时PF升高，Z组和APP组术后24 h引流量减少，异体血浆输注量和红细胞输注量减少，异体红细胞输注率和异体血浆输注率降低（P〈0.05或〈0.01）。与Z组比较，APP组T3时PF升高（P〈0.05）。 结论：急性Plt分离或自体血回输对体外循环冠状动脉旁路移植术患者具有相似的血液保护作用, 但是前者可以增强血小板功能。

Objective ：To compare the blood-saving effects of acute plateletpheresis （APP） and autologous blood during back-transfusion in patients undergoing coronary artery bypass grafting （CABG） by CPB. Methods：Sixty ASA Ⅱ or Ⅲ patients aged 40-65 years, weighing 70-103 kg , scheduled for CABG with CPB were randomly divided into 3 groups （n=20 each）：control group（group C）,atologous blood group（group Z） and APP group. In APP group and group Z, platelet-rich plasma and autologous blood were collected immediately after induction of anesthesia and transfused back to the patient 10 min after neutralization of heparin with protamine. Hb, Plt, clot rate（CR） and platelet function （PF） were measured 5 min after induction（T1）, 10 min after neutralization of heparin （T2） and immediately after operation. CPB time （T3）, aortic crossclamping time , closing chest time , postoperative chest tube drainage and blood product requirements were recorded. Results：The platelet count and CR at T3 were higher in other two groups than in group C, PF at T3 was higher in APP group than in group C. The volume of postoperative chest tube at 24h after operation, allogeneic plasma and RBC volume,the incidence of allogeneic RBC and plasma were lower in other two groups than in group C. PF at T3 was higher in APP group than in group Z （P〈0.05 or P 〈0.01）. Conclusion：APP and atologous blood may have similar blood-saving effect in patients undergoing CABG with CPB,but APP may increase the platelet function.