主动脉全弓置换术中自体血小板分离采集的麻醉管理

Anesthesia management for autologous plateletpheresis during aortic arch replacement surgery

目的:总结主动脉全弓置换术患者术中应用自体血小板分离技术的麻醉管理经验。方法:收集本院61例术中应用自体血小板分离技术的主动脉全弓置换术的临床麻醉资料,统计术中血小板分离采集的结果及采集过程中患者的心率、血压、血管活性药应用、术后并发症等数据,回顾分析术中血小板分离采集技术对麻醉管理的影响。结果:61例患者除1例在血小板分离采集过程中发生室颤抢救而中止采集外,其余患者均顺利完成全部采集过程,平均处理全血(2 265±386)m L,采集血小板(230±52)m L,分离血浆(926±152)m L、红细胞悬液(592±124)m L。分离采集过程对血流动力学影响较为明显,主要包括低血压(65.6%)、心动过速(23%)、心动过缓(9.8%)等,除1例因严重低血压诱发室颤(抢救成功)外,其余均为短暂性出现或处理后迅速好转,血管活性药总使用率43.5%。术后无麻醉相关并发症和死亡病例。结论:术中自体血小板分离技术对循环功能有一定的影响,主要表现为低血压和心率改变,麻醉管理需密切监测和综合调控血流动力学状态,以维持循环稳定并保障患者生命安全。

Objective：To summarize the experience of anesthesia management in aortic arch replacement surgery using autolo- gous plateletpheresis technique. Methods：Collected the clinical data of 61 patients undergoing total aortic arch replacement using autol- ogous plateletpheresis technique in our hospital were collected, the results of intraoperative platelet separation and the data of heart rate, blood pressure, vasoactive drugs and postoperative complications were collected. Retrospective analysis the effect of intraoperative plate- let separation and collection technique on anesthesia management. Results：The whole plateletpheresis process was accomplished suc- cessfully in all cases except one patient who encountered a ventricular fibrillation induced by a severe hypotension during the plateletph- eresis process. During the operation period, （2,265 ± 386）mL of whole blood were processed and divided into autologous platelet-rieh plasma （230 ±52）mL, autologous plasma （926± 152）mL, and autologous red cells （592 ± 124）mL. The separation and collection process had obvious influence on hemodynamics,including hypotension （65.6%） , tachycardia （23%） , bradycardia （ 9.8% ） and so on. Except for 1 cases of ventricular fibrillation caused by severe hypotension （ rescue success） ,the rest of them were transient or rapid- ly improved after treatment. And the total usage rate of vasoactive agents was 43.5%. There were no related anesthesia complications and dead cases in the perioperative period. Conclusion：Autologous plateletpheresis technology has a certain impact on the circulatory function, mainly for low blood pressure and heart rate changes, anesthesia management should be closely monitored and comprehensive regulation of hemodynamics,to maintain circulation stability and protect the safety of patients.