自体血小板分离回输对体外循环心脏直视手术患者血液的保护作用

目的 评价自体血小板分离(autologous patelet-richplasma, aPRP)回输对体外循环心脏直视手术患者的血液保护作用。方法 选择体外循环心脏直视手术患者90例,将患者随机分为对照组(n=45)和自体血小板分离组(aPRP组,n=45)。aPRP组在麻醉诱导后行血小板分离,在肝素化之前完成富血小板血浆提取,于体外循环结束、鱼精蛋白中和肝素后回输,对照组不行血小板分离。于术前,术后1、24和48h记录Hb、Plt、PT、APTT及Fib,记录体外循环时间、主动脉阻断时间、术后引流量、输血情况。结果 aPRP组采集并回输富血小板血浆(323±117)ml,Plt分离时间(45±8)min。与对照组比较,aPRP组术后24h内引流量、输注异体血率下降(P＜0.05)。结论 自体血小板分离回输可改善体外循环心脏直视手术患者的凝血功能,降低术后出血量和异体血输注,具有血液保护作用。
Objective To assess the application of reinfusion of autologous platelet rich plasma(aPRP) in cardiac surgery with cardiopulmonary bypass. Methods Ninety patients undergoing cardiac surgery with cardiopulmonary bypass were assigned to receive aPRP(n=45) or no to receive aPRP(n=45). The plateletpheresis performed before heparinization. Hemoglobin(Hb), platelet(Plt), prothrombin time(PT), activated partial thromboplastin time(APTT) and fibrinogen were measured before operation and 1, 24, 48h after operation. Cardiopulmonary bypass time, aortic crossing time, postoperative drainage volume at 1, 24h after operation and allogeneic blood transfusion volume were recorded. Results In aPRP group, the volume of aPRP reinfused was(323±117)ml. The plateletpheresis process took(45±8)min. Comparing with control group, the volume of postoperative drainage at 1 and 24h was significantly reduced in aPRP group. The transfusion rate of packed red blood cells were also reduced in the aPRP group. Conclusion Our results demonstrate that preoperative plateletpheresis and reinfusion can improve the coagulation function of patients undergoing cardiac surgery, and reduce the postoperative blood loss and blood transfusion