| 急性血小板分离或自体血回输对体外循环冠状动脉旁路移植术患者血液保护的影响 |
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| 引用本文： | 王永旺
王永旺,喻文立,王清平,翁亦齐,杜洪印,王 刚,于泳浩.急性血小板分离或自体血回输对体外循环冠状动脉旁路移植术患者血液保护的影响[J].天津医科大学学报,2016,0(6):494-497. |
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| 作者姓名： | 王永旺
王永旺 喻文立 王清平 翁亦齐 杜洪印 王 刚 于泳浩 |
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| 作者单位： | （1.天津医科大学一中心临床学院麻醉科，天津 300192；2.天津医科大学总医院麻醉科，天津 300052） |
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| 摘 要： | ?目的:比较急性血小板（Plt）分离与自体血回输对体外循环（CPB）冠状动脉旁路移植术（CABG）患者的血液保护效果。 方法:择期拟在CPB下CABG 患者60例，ASA分级Ⅱ级或Ⅲ级，年龄40～65岁，体质量70～103 kg。采用随机数字表法，将患者随机分为3组（n=20）:对照组（C组）、自体血回输组（Z组）和急性Plt分离组(APP组)。APP组在麻醉诱导后行APP，提取富Plt血浆，于CPB结束鱼精蛋白中和肝素后10 min回输，Z组在麻醉诱导后行自体血放血入枸橼酸保存液血袋，回输同APP组，C组不作处理。于麻醉诱导后5 min（T1）、鱼精蛋白中和肝素后10 min（T2）和术后即刻（T3），采集中心静脉血样，检测血常规和Sonoclot凝血及血小板功能，记录Hb、Plt、凝血速率（CR）及血小板功能（PF）。记录CPB时间、主动脉阻断时间、关胸时间、术后引流量和输血情况。结果:与C组比较，Z组和APP组T3时Plt、CR升高，APP组T3时PF升高，Z组和APP组术后24 h引流量减少，异体血浆输注量和红细胞输注量减少，异体红细胞输注率和异体血浆输注率降低（P<0.05或<0.01）。与Z组比较，APP组T3时PF升高（P<0.05）。 结论:急性Plt分离或自体血回输对体外循环冠状动脉旁路移植术患者具有相似的血液保护作用, 但是前者可以增强血小板功能。
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| 关 键 词： | 血小板 输血 自体 心肺转流术 冠状动脉旁路移植术 Sonoclot血小板功能分析仪 |
Blood-saving effects of acute plateletpheresis and autologous blood transfusion in patients undergoing coronary artery bypass grafting by CPB |
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| WANG Yong-wang' target="_blank" rel="external">
WANG Yong-wang,YU Wen-li,WANG Qing-ping,WENG Yi-qi,DU Hong-yin,WANG Gang,YU Yong-hao?.Blood-saving effects of acute plateletpheresis and autologous blood transfusion in patients undergoing coronary artery bypass grafting by CPB[J].Journal of Tianjin Medical University,2016,0(6):494-497. |
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| Authors: |
WANG Yong-wang" target="_blank">WANG Yong-wang' target="_blank" rel="external">
WANG Yong-wang YU Wen-li WANG Qing-ping WENG Yi-qi DU Hong-yin WANG Gang YU Yong-hao? |
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| Affiliation: | (1.Deparment of Anesthesiology，The First Center Clinical College，Tianjin Medical University，Tianjin 300192, China；2.Department of Anesthesiology，General Hospital，Tianjin Medical University，Tianjin 300052，China) |
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| Abstract: | Objective :To compare the blood-saving effects of acute plateletpheresis (APP) and autologous blood during back-transfusion in patients undergoing coronary artery bypass grafting (CABG) by CPB. Methods:Sixty ASA Ⅱ or Ⅲ patients aged 40-65 years, weighing 70-103 kg , scheduled for CABG with CPB were randomly divided into 3 groups (n=20 each):control group(group C),atologous blood group(group Z) and APP group. In APP group and group Z, platelet-rich plasma and autologous blood were collected immediately after induction of anesthesia and transfused back to the patient 10 min after neutralization of heparin with protamine. Hb, Plt, clot rate(CR) and platelet function (PF) were measured 5 min after induction(T1), 10 min after neutralization of heparin (T2) and immediately after operation. CPB time (T3), aortic crossclamping time , closing chest time , postoperative chest tube drainage and blood product requirements were recorded. Results:The platelet count and CR at T3 were higher in other two groups than in group C, PF at T3 was higher in APP group than in group C. The volume of postoperative chest tube at 24h after operation, allogeneic plasma and RBC volume，the incidence of allogeneic RBC and plasma were lower in other two groups than in group C. PF at T3 was higher in APP group than in group Z (P<0.05 or P <0.01). Conclusion:APP and atologous blood may have similar blood-saving effect in patients undergoing CABG with CPB，but APP may increase the platelet function. |
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| Keywords: | blood platelets blood transfusions autologous cardiopulmonary bypass coronary artery bypass grafting sonoclot coagulation and platelet function analyzer |
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