自体血小板分离回输技术应用于急性A型主动脉夹层患者临床治疗综合效果的分析与评价

Comprehensive Effect of Autologous Plateletpheresis and Transfusion Technology in Patients with ATAAD

目的 探讨自体血小板分离回输技术应用于急性A型主动脉夹层(ATAAD)患者的临床综合治疗效果。方法 回顾性分析2020年1月—2023年4月本院收治的125例ATAAD患者的临床资料,根据是否进行自体血小板分离(APP)与回输,将患者分为APP组59例和non-APP组66例。记录两组患者术前(T0)、术后24 h(T1)、术后48 h(T2)及术后72 h(T3)凝血指标及肝肾指标水平;记录两组患者血小板(PLT)水平、异体血输注量、手术时间、机械通气时间、术后纵隔引流量、ICU住院时长、住院总花费及术后并发症发生率。结果 在T1-T3时,APP组凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)明显短于non-APP组(P<0.05),纤维蛋白原(FIB)水平高于non-APP组(P<0.05);观察术后肝功能参数,与non-APP组相比,APP组谷丙转氨酶(ALT)、谷草转氨酶(AST)水平在T1、T2时相对较低(P<0.05),乳酸脱氢酶(LDH)在T1、T2、T3时均维持在较低水平(P<0.05),直接胆红素(DBil)、总胆红素(TBil)水平在T1时较non-APP组低(P<0.05);观察术后肾功能参数,APP组血清肌酐(SCr)及血尿素氮(BUN)水平在T1、T2、T3时均显著低于non-APP组(P<0.05);从血液保护角度考虑,相比于non-APP组,T1时APP组PLT维持在较高水平(P<0.05),且APP组围术期异体红细胞、血小板、血浆和冷沉淀输注量相对较少(P<0.05);观察术后转归情况,与non-APP组相比,APP组术后机械通气时间及ICU住院时长缩短,住院总费用更低,术后24 h纵隔引流量更少(P<0.05);观察两组术后并发症,APP组急性肾损伤发生率明显低于non-APP组(P<0.05)。结论 自体血小板分离回输技术能有效改善ATAAD患者凝血功能,对术后肝肾功能保护、血液保护作用明显,加快患者术后康复和转归。另外,此项技术的开展有助于减轻患者经济负担,取得良好的社会效应与经济效益。

Objective To investigate the clinical effect of autologous plateletpheresis(APP)transfusion in patients with acute type A aortic dissection(ATAAD).Methods The clinical data of 125 ATAAD patients admitted to our hospital from January 2020 to April 2023 were retrospectively analyzed.The patients were divided into APP group(n=59)and non-APP group(n=66)based on whether APP and transfusion performed.The levels of coagulation indexes and liver and kidney indexes were recorded at preoperative(T0),24 h postoperative(T1),48 h postoperative(T2),and 72 h postoperative(T3).Platelet count,the amount of allogeneic blood transfusion,duration of surgery,duration of mechanical ventilation,volume of mediastinal drainage in the postoperative period,length of stay in the ICU,hospitalization cost,and rate of postoper ative complications were recorded.Results At T1-T3,PT and APTT in the APP group were significantly shorter than those in the non-APP group(P<0.05),and the level of FIB was higher than that in the non-APP group(P<0.05).The liver function parameters after operation were observed.Compared with the non-APP group,the levels of ALT and AST in the APP group were relatively lower at T1 and T2(P<0.05);LDH was maintained at lower levels at T1,T2,and T3(P<0.05);the levels of DBil and TBil were lower than those in the APP group at T1(P<0.05).Postoperative renal function parameters were observed.SCr and BUN levels in the APP group were significantly lower than those in the non-APP group at T1,T2,and T3(P<0.05).From blood protection,compared with the non-APP group,PLT in the APP group maintained a high level at T1(P<0.05),and the amount of perioperative allogeneic red blood cells,platelets,plasma and cryoprecipitate transfusion in the APP group was relatively lower(P<0.05).The postoperative outcomes were observed.Compared with the non-APP group,duration of mechanical ventilation and length of stay in the ICU in the APP group were shorter;total hospitalization cost was lower;the volume of mediastinal drainage at 24 h after surgery was lower(P<0.05).The postoperative complications were observed.The incidence of acute kidney injury in the APP group was significantly lower than that in the non-APP group(P<0.05).Conclusion Autologous plateletpheresis and transfusion technology can effectively improve the coagulation function of ATAAD patients and have obvious effects on postoperative liver and kidney function protection and blood protection,and accelerate postoperative recovery and regression.The application of this technology is helpful to reduce the economic burden of patients and achieve good social and economic effects.