术前急性自体血小板分离回输在体外循环心脏手术中的血液保护效果

目的探讨术前急性自体血小板(Plt)分离回输在体外循环心脏手术中的血液保护效果。方法 36名择期体外循环心脏手术患者,ASAⅡ~Ⅲ级,年龄24~60岁,体重53~71 kg。将患者随机分为两组(n=18):对照组(A组)和急性Plt分离组(B组)。A组行单纯术中自体血回收,B组行急性等容血液稀释(ANH)联合自体富血小板血浆(PRP)回输及术中自体血回收,整个Plt分离过程在肝素化之前完成。于麻醉诱导前(T1)、肝素化前(T2)、术后1 h、24 h和48 h(T3、T4、T5)各时点记录相关血液凝血功能各项指标。记录ECC时间、主动脉阻断时间、术后1 h、24 h引流量和异体输血量。结果 B组急性Plt分离处理的全血容量为(1150±168)ml,采集富Plt血浆(177±32)ml,其中Plt计数(1 060±255)×109/L,占全身血容量Plt总数(25±4)%,Plt分离时间(38±11)min。与A组比较,B组术后1 h时Plt计数明显升高,术后1 h、24 h引流量、异体红细胞、Plt输注量和异体Plt输注率降低(P<0.05或0.01),其余指标差异无统计学意义(P>0.05)。结论术前自体血小板分离回输联合术中自体血回收可改善心脏手术患者的凝血功能,并降低术后出血量和异体血的输注。

Blood- saving effect of preoperative acute plateletpheresis and back- transfusion for patients undergoing cardiac surgery with extracorporeal circulation

Objective To probe the blood - saving effect of preoperative acute plateletpheresis （APP） and back - transfusion for patients undergoing cardiac surgery with extracorporeal circulation （ECC）. Methods 36 ASA II or III patients aged 24 - 60 yrs and weighted 53 -71 kg undergoing cardiac surgery with ECC were randomly divided into 2 groups （n = 18） ： control group （group A） and APP group （group B）. In group A, merely intraoperative autotransfusion was applied. While in group B, combined acute normov- olemic hemodilution and autologous platelet - rich plasma back - transfusion and intraoperative autotransfusion were applied. The whole plateletpheresis process was completed before heparinization. Hemoglobin （ Hb）, platelet （Plt）, prothrombin time （ PT）, activated partial thromboplastin time （APTI＇） and fibrinogen （Fib） of blood samples were measured before anesthesia induction, pre -hepa- rinization and at 1, 24 and 48 hour after operation. ECC time, aortic crossclamping time, postoperative drainage volume at 1 h, 24 h after operation and allogeneic blood transfusion volume were recorded. Results In group B, the volume of the whole blood processed for plateletpheresis was （ 1150 ± 168） ml and （ 177 ± 32） ml of platelet - rich plasma （PRP） was collected. The platelet count of the PRP was （ 1060± 255 ） × 109/L, accounting for （25 ± 4） % of the total number of platelet in the whole blood volume. The plateletph- eresis took （38 ± 11 ） min. Comparing with that in group A, the platelet count at 1 h after operaion was obviously higher, and the vol- ume of postoperative drainage at 1 h, 24 h was obviously reduced in group B. Less allogeneic RBC and platelet were transfused in group B than group A. There was no significant difference in other index between the 2 groups. Conclusion Preoperative plateletph- eresis and back - transfusion combined with autotransfusion can improve the coagulation function of patients undergoing cardiac surgery, also can ruduce the postoperative blood loss and allogeneic blood transfusion.