术中自体血回收对血小板活化及凝血功能的影响

目的探讨术中自体血回收对回收血中血小板活化及凝血功能的影响。方法将40例出血量≥800ml的骨科择期手术患者随机分为2组,每组20例。A组术中进行自体血回收,并在术中予以回输;B组为对照组,术中按需输注异体血。测量各组患者5个时间点的凝血酶原时间（PT）、部分凝血活酶时间（APTT）、凝血酶时间（TT）、纤维蛋白原（FIB）、血小板计数（PLT）以及血小板膜糖蛋白纤维蛋白原受体（PAC-1）、P-选择素（CD62P）的表达量,同时测量A组回收血中的PLT及血小板PAC-1、CD62P的表达量。结果两组间PT、APTT、TT、FIB的变化差异无统计学意义（P〉0.05）。两组术后血小板PAC-1的表达均高于术前（P〉0.05）。A组回收血中PLT显著低于体内血（P〈0.01）,而血小板PAC-1和CD62P表达量则显著高于体内血（P〈0.01）。结论自体血回收可引起回收血中血小板的活化,但在一定范围内并未引起不良反应。其对凝血指标和血小板活化程度的改变与输注异体血基本一致。所以,术中自体血回收是安全的,可以起到节约用血、减少异体输血反应的作用。

Effect on Intraoperative Autologous Blood Salvage on Platelet Activation and Blood Coagulation Function

Objective To investigate the effect of intraoperative autologous blood salvage on platelet activation and blood coagulation. Methods Forty patients with selective orthopedic surgery （estimated blood loss≥ 800 ml）were randomly divided into two groups （n= 20 in each） . In group A, an autotranfusion device was used to collect and reinfuse autologous blood during operation,while an allogenic blood transfusion was conducted in group B as control, prothrombin time （PT）, activated partial thromboplastin time （APTT）, thrombin time （TT）, fibrinogen （FIB）, platelet count （PLT）, and expression of PAC-1, CD62P on platelets were detected at five different time points. Additionally, platelet counts and ex pression of PAC 1, CD62P on platelets in the salvaged blood were detected. Results The expression of PAC 1 and CD62P in salvaged blood in group A was significantly higher than those in vivo（P〈0. 01） ,while PLT was low （P〈0.01）. However, there were no significant differences in PT ,APTT ,TT ,FIB and expression of PAC 1 or CD62P between two groups （P 〉0.05）. Conclusions Platelets are activated in the process of autologous blood salvage, and there are still some platelets in washed RBC. But the activated platelets cause any adverse reation within a certain range. The intraoperative autotranfu sion is safe, and can play an effect on blood conservation and reduce blood transfusion adverse reactions.