围手术期自体血回收分离机制备富血小板血浆和自体凝血酶的研究

Study on Preparation of Platelet-rich Plasma and Autologous Thrombin by Perioperative Autologous Blood Recovery System

目的验证围手术期使用自体血回收分离机制备富血小板血浆(PRP)的可行性及有效性,探索制备自体凝血酶并用以制备富血小板凝胶(PRG)的方法。方法选取2018年10月至2019年1月在北京积水潭医院行单侧全髋关节置换术的30例患者,按照随机数字法分为观察组和对照组,每组15例。所有患者均在手术前30 min使用自体血回收分离机制备PRP,采血前后检测患者血红蛋白、血小板(PLT)及白细胞(WBC),并检测PRP中的PLT及WBC水平及富集程度。其中,观察组取PRP 1.5 mL加入10%葡萄糖酸钙,经水浴、离心制备自体凝血酶,使用自体凝血酶激活PRP制备PRG;对照组使用10%葡萄糖酸钙激活PRP,30 min内观察并记录两组PRP被激活形成凝胶的时间。结果30例患者PRP制备均完成,血流动力学无明显波动。两组患者的PRP生成量、PLT基础值、PRP中PLT含量及富集度,WBC基础值、PRP中WBC含量及富集度比较差异无统计学意义(P>0.05)。激活物与PRP混合后,观察组12例2 min时凝集成凝胶,3例3 min时凝集;对照组15例30 min时均未凝集。结论围手术期可利用自体血回收分离机制备自体PRP,其所得产物PLT及WBC可达到治疗水平,且使用PRP水浴离心制备自体凝血酶,作为激活剂制备PRG方法可行。

Objective To validate the feasibility and effectiveness of preparing platelet-rich plasma(PRP)during perioperative period by autologous blood recovery system,and explore the method of preparing autologous thrombin for platelet rich gel(PRG).Methods A total of 30 patients scheduled for total hip arthroplasty in Beijing Jishuitan Hospital from Dec.2018 to Jan.2019 were included in the study and divided into an observation group and a control group according to the random number method,15 cases each.PRP were prepared using autologous blood recovery system for all patients 30 min before operation.Hemoglobin,platelet(PLT)and white blood cell(WBC)were measured before and after blood collection.PLT and WBC in PRP were measured,and the degree of enrichment were calculated.In the observation group,PRP 1.5 mL was added with 10%calcium gluconate,then the thrombin was prepared by water bath and centrifugation,and PRG was prepared by activating PRP with autothrombin.The control group used calcium gluconate 10%to activate PRP,and time of PRP activated to form gel of the two groups was observed and recorded within 30 min.Results PRP preparation was completed in 30 patients,and there was no significant fluctuation in hemodynamics.There were no significant differences in PRP production amount,PLT basic value,PLT content and enrichment degree in PRP,WBC basic value and WBC content and enrichment degree in PRP between the two groups(P>0.05).After the mixture of the activator and PRP,the coagulation finished at 2 min in 12 cases,at 3 min in 3 cases in the observation group,while in the control group all 15 cases did not coagulate within 30 min.Conclusion The PRP can be prepared by the mechanism of autologus blood recovery and separation system during perioperative period,and the products PLT and WBC can reach the treatment level.It is feasible to use PRP water bath centrifugation to prepare thrombin as activator to prepare PRG.