术前自体血小板分离回输在非体外循环下冠状动脉旁路移植术中的应用

目的 探讨术前自体血小板分离回输在非CPB下冠状动脉旁路移植术(off-pump coronary artery bypass grafting,OPCABG)中应用的临床效果. 方法 32例OPCABG患者采用随机数字表法分为两组(每组16例):对照组(A组)行术中自体血回输,急性血小板分离组(B组)行急性等容血液稀释(acute normovoemic hemodiltion,ANH)联合自体富血小板血浆(platelet-rich plasma,PRP)回输及术中自体血回输.于麻醉诱导前(T0)、肝素化前(T1)、术后1 h(T2)、术后24 h(T3)各时间点记录有关凝血功能的各项指标.记录T2、T3时点引流液. 结果 B组急性血小板处理的全血容量为(1 100±145) ml,采集PRP(166±30) ml,血小板计数(platelet count,Plt)(1 010±210)×109/L,占全身Plt总数(26±3)％.与A组比较,B组T2时点Plt升高明显,T2、T3时点引流液降低、异体红细胞输注率降低(P＜0.05),凝血功能指标差异无统计学意(P＞0.05). 结论 术前自体血小板分离回输在OPCABG中可减少异体血输注量,减少输血费用,降低术后出血量,避免血液传播性疾病及输血反应的发生.

The application of preoperative autologous plateletpheresis and back-transfusion in off-pump coronary artery bypass grafting

Objective To explore the clinical effect of preoperative autologous plateletpheresis and back-transfusion in offpump coronary artery bypass grafting (OPCABG).Methods Thirty two patients undergoing OPCABG were randomly divided into 2 groups (n=16):control group (group A) and acute platelepheresis group (group B).In group A,intraoperative autotransfusion was applied.In group B,combined acute normovoemic hemodiltion and autologous platelet-rich plasma back-transfusion and intraoperative autotransfusion were applied.Hb,platelet count(Plt),prothrombin time(PT),activated partial thromboplastin time(APTT) and fibrinogen (Fib) were measured before anesthesia induction(T0),pre-heparinization(T1) and at 1,24 h after operation(T2,T3).Postoperativ drainage volume at 1 and 24 h after operation were recorded.Results In group B,volume of the whole blood for acute plateletpheresis was (1 100±145) ml.Volume of platelet-rich plasma(PRP) collected was (166±30) ml.Plt of the PRP was (1 010±210)×10g/L,accounting for (26±3)％ of the total number of platelet in the whole blood volume.Compared with group A,the Plt at 1 h after operation was obviously higher in group B.The drainage volume at 1,24 h after operation was obviously reduced in group B.Less allogeneic RBC were transfused in group B than group A.Coagulation tests showed no significant difference in both group.Conclusions Preoperative acute plateletpheresis and back-transfusion in OPCABG can ruduce the amout of allogenic blood transfusion and postoperative blood loss and blood transfusion costs,meanwhile can avoid blood transmitted diseases and transfusion reaction.