自体血小板分离技术在A型主动脉夹层手术患者的应用

Application of autologous platelet separation technique in patients undergoing surgery for type A aortic dissection

目的观察自体血小板分离技术在A型主动脉夹层手术患者的应用效果。方法行A型主动脉夹层手术患者68例,随机分为两组:试验组32例,术中应用自体血小板分离制备富血小板血浆,给予鱼精蛋白中和肝素后回输给患者;对照组36例,进行常规血液回收,未行自体血小板分离。在麻醉诱导后肝素化之前(T1)、鱼精蛋白中和肝素且富血小板血浆回输后5 min(T2)、术后1 h(T3)、术后24 h(T4)检测患者血小板计数。比较两组术中及术后情况。结果在T2、T3、T4时,试验组血小板计数高于对照组(P<0.05)。两组患者手术时间、体外循环时间、主动脉阻断时间、深低温停循环时间、血小板输入量、机械通气时间、ICU停留时间比较无统计学差异(P>0.05),试验组患者红细胞输入量、血浆输入量以及冷沉淀输入量少于对照组(P<0.05)。两组并发症发生情况及死亡情况比较无统计学差异(P>0.05)。结论 A型主动脉夹层手术中应用自体血小板分离可以有效减少输血量。

Objective To observe the application efficiency of autologous platelet separation technique in the patients undergoing surgery for type A aortic dissection.Methods A total of 68 cases underwent type A aortic dissection operation was randomly divided into two groups.The platelet-rich plasma was prepared by autologous platelet separation during operation in group A(32 cases),which was given back to the patients after protamine neutralizing heparin.The routine blood collection was performed without autologous platelet separation in group C(36 cases).The platelet count was detected before heparinization and after induction of anesthesia(T1),protamine neutralizing heparin and 5 minutes after platelet-rich plasma reinfusion(T2),one hour(T3) and 24 hours(T4) after operation.The operation-related indicators were compared between two groups.Results The platelet count at T2,T3 and T4 was higher in group A than that in group C(P<0.05).The time of operation,extracorporeal circulation,aortic cross clamping and deep hypothermic circulatory arrest,platelet input,mechanical ventilation time and ICU stay were all not significantly different between two groups(P>0.05).The transfusions of red blood cells,plasma and cryoprecipitation were lower in group A than those in group C(P<0.05).The complications and death were not significantly different between two groups(P>0.05).Conclusion The use of autologous platelet separation can effectively reduce the amount of blood transfusion in the patients undergoing surgery for type A aortic dissection.