自体血小板分离回输在Stanford A型主动脉夹层手术中血液保护作用的随机对照试验

Protective effect of autologous platelet separation on blood in surgery for Standford type A aortic dissection: A randomized controlled trial

目的探讨自体血小板分离回输在主动脉夹层手术中的血液保护效果。方法选取2014年7月至2016年3月行大血管手术的Stanford A型夹层患者180例,其中男123例、女57例,年龄19~69岁,体质量50~85 kg,美国标准协会分级(American Standards Association,ASA)Ⅱ~Ⅳ级。将患者随机分为两组,A组[92例,男65例、女27例,年龄(45±21)岁]采用单纯术中自体血回收;B组[88例,男58例、女30例,年龄(43±24)岁]采用自体富血小板血浆(autologous platelet rich plasma,APRP)回输及术中自体血回收,整个血小板分离过程在肝素化之前完成。于麻醉诱导前(T_1)、肝素化前(T_2)、出手术室时(T_3)和术后1 h(T_4)、术后24 h(T_5)各时点检测血小板及血液凝血功能相关各项指标。记录体外循环时间、主动脉阻断时间、术后l h、术后24 h伤口引流量和异体输血量。结果 B组急性血小板分离处理的全血容量为(1 305±110)ml,采集富血小板血浆(275±30)ml,其中血小板计数(630±220)×10~9/L,占全身血容量血小板总数25%±5%,血小板分离时间(32±9)min。与A组比较,B组术后1 h时血小板计数明显升高,术后1 h、24 h胸腔引流量、24 h异体红细胞、血浆输注量和异体血小板输注量显著降低(P<0.05);B组纤维蛋白酶原(FIB)、凝血速率(CR)、血小板功能(PF)与A组相比差异有统计学意义(P<0.05);B组术后并发症发生率与A组相比也明显下降(P<0.05)。结论对于大血管手术患者,术前急性自体血小板分离联合术中自体血回收可明显改善其凝血功能,并降低了术后出血量、异体血的输注及术后并发症发生率,也改善了患者预后,缩短了住院时间。

Objective To investigate the protective effect ofautologous platelet separation on blood in surgery for Standford type A aortic dissection. Methods A total of 180 patients with Standford type A aortic dissection undergoing elective ma）or vascular surgery in our hospital from July 2014 to March 2016 were enrolled. There were 123 males and 57 females with age ranging from 19 to 68 years and weight of 50-85 kg. The patients were randomly divided into two groups. Patients in group A （n=92, 65 males, 27 females, mean age of 45±21 years） received intraoperative autologous blood recovery; while those in group B （n=88, 58 males, 30 females, mean age of 43＋24 years） received autologous platelet rich plasma （APRP） and intraoperative autologous blood recovery. The whole process of platelet separation was completed before heparinization. The relevant indicators of blood coagulation function before the induction of anesthesia （T1）, before heparinization （T2）, immediately postoperatively （T3） and 1 h （T4）, 24 h （T5） postoperatively were measured. Cardiopulmonary bypass, aortic cross-clamping time, drainage volume at postoperative 1 h, 24 h and allogeneic blood transfusion volume were recorded. Results The whole blood volume of group B in the platelet separation in emergency was 1 305± 110 ml, and collected platelet rich plasma was 275±30 ml, platelet counts （630±220）×109/L, accounting for 25%±5% of platelets of whole blood, and platelet separation time was 32±9 min. Compared with group A, platelet count at postoperative 1 h in group B was significantly higher; drainage volume at postoperative 1 h, 24 h, allogeneic red blood cells, plasma transfusion volume and allogeneic platelet infusion rate decreased significantly （P〈0.05）. Group B had less postoperative complications （P〈0.05）. Conclusion Preoperative autologous plateletpheresis combined with intraoperative autologous blood recovery can significantly improve the coagulation function of patients with vascular surgery, and reduce the amount of allogeneic blood transfusion and postoperative bleeding.