自体富血小板血浆对心脏瓣膜手术患者术后出血和预后的影响

Effect of autologous platelet⁃rich plasma on postoperative bleeding and prognosis of patients undergoing heart valve surgery

目的观察自体富血小板血浆(autologous platelet rich plasma,aPRP)对心脏瓣膜手术患者术后出血和预后的影响。方法本研究为一项回顾性队列研究,纳入2018年9月至2023年1月在复旦大学附属中山医院厦门医院行心脏瓣膜手术的患者。根据患者术前是否行aPRP采集为两组:A组为对照组(未行PRP采集),B组为研究组(PRP采集组)。主要观察终点指标为手术当天(D0)、术后第1天(D1)、术后第2天(D2)的心包纵膈引流量;次要观察终点指标为术后机械通气时间、心包纵膈引流管留置时间、ICU停留时间、术后住院时间、术后住院期间的不良事件发生率和术后的凝血功能。通过倾向性得分匹配平衡术前基线,匹配因素包括:性别、年龄、BMI、凝血酶原时间(prothrombin time,PT)、国际标准化比值(international normalized ratio,INR)、血小板(platelet count,PLT)、激活全血凝固时间(activated clotting time,ACT)、ASA分级、NYHA分级、手术名称、手术方式、术前合并症,对匹配后的数据分析PRP对心脏瓣膜手术患者术后出血和预后的影响。结果在倾向性得分匹配后,与A组相比,B组患者D2引流量[(132.42±84.11)vs.(218.39±160.39),P=0.01]明显减少;B组的术后机械通气时间[(1.88±0.99)vs.(2.78±2.47),P=0.015]、ICU停留时间[(3.07±2.01)vs.(4.97±6.26),P=0.006]和心包纵膈引流管留置时间[(5.72±1.85)vs.(9.23±5.05),P=0.01]显著缩短,总体不良事件发生率减少[8.3%(5/60)vs.23%(14/60),P=0.024];两组患者在住院时间和术后D0、D1、D2的凝血功能差异无统计学意义。结论PRP可减少术后第2天心包纵隔引流量,并缩短术后机械通气、ICU停留、心包纵膈引流管留置时间,降低术后总体不良事件的发生率。

Objective To investigate the impact of autologous platelet-rich plasma on postoperative bleeding and patient prognosis in individuals undergoing heart valve surgery.Methods This study is a retrospective cohort study that included patients who underwent heart valve surgery at Xiamen Hospital,Zhongshan Hospital,Fudan University from September 2018 to January 2023.The patients were divided into two groups based on whether they underwent autologous platelet-rich plasma(aPRP)collection before surgery:Group A(no PRP collection)and Group B(PRP collection group).The main endpoint measure was the volume of pericardial mediastinal drainage on the day of surgery(D0),the first postoperative day(D1),and the second postoperative day(D2).The secondary endpoint indicators included postoperative mechanical ventilation time,duration of mediastinal drainage tube reten‐tion,length of stay in the intensive care unit(ICU),postoperative hospitalization time,incidence of adverse events during postoperative hospitalization,and postoperative coagulation function.Propensity score matching was used to balance preoperative baseline characteristics,including gender,age,Body Mass Index(BMI),prothrombin time(PT),International Normalized Ratio(INR),platelet count(PLT),activated clotting time(ACT),ASA grade,NYHA grade,surgical name,surgical method,and preoperative comorbidities.Based on the matched vdata,the effect of PRP on postoperative bleeding and prognosis in patients following heart valve surgery was investi‐gated.Results After propensity score matching,Group B patients showed a significant decrease in D2 drainage volume compared to Group A[(132.42±84.11)vs.(218.39±160.39),P=0.01].Additionally,Group B had significantly shorter postoperative mechanical ventilation time[(1.88±0.99)vs.(2.7±2.47),P=0.015],ICU stay time[(3.07±2.01)vs.(4.97±6.26),P=0.006],and pericardial mediastinal drainage retention time[(5.72±1.85)vs.(9.23±5.05),P=0.01].Moreover,the overall incidence of adverse events was reduced in Group B compared to Group A[5(8.3%)vs.14(23%),P=0.024].At D0,D1,and D2,there was no statisti‐cally significant difference in hospital stay or postoperative coagulation function between the two groups of patients.Conclusions PRP has been proven to minimize pericardial mediastinal drainage on the second postoperative day,as well as the duration of mechanical ventilation,ICU stay,retention of pericardial mediastinal drainage,and over‐all incidence of postoperative adverse events.