自体血小板分离联合术中自体血回输在脊柱侧弯矫形术中的价值

目的探讨自体血小板分离联合术中自体血回输技术在脊柱侧弯矫形术中的临床价值。方法 60例行脊柱侧弯手术患者随机分为三组,每组20例。Ⅰ组:术前自体血小板分离并制备富血小板血浆（PRP）,术中自体血回收,手术结束前回输PRP;Ⅱ组:仅行术中自体血回收,未进行自体血小板分离回输;Ⅲ组:未进行血液保护措施。测定Ⅰ组手动提取PRP中血小板计数（Plt）,于麻醉诱导前（T₁）、自体血小板分离后10 min（T₂）、输自体回收血及PRP前10 min（T₃）、输自体回收血及PRP后10 min（T₄）、术后24 h（T₅）、术后48 h（T₆）各时点测Hb水平、凝血功能、Plt和血小板聚集功能;比较手术时间、术中出血量、术后24、48 h切口总引流量、术中及术后48 h异体血输入量。结果三组手术时间、术中出血量差异无统计学意义;T₃、T₄时三组Plt和血小板聚集功能明显低于T₁时（P<0.01）。与Ⅰ组比较,T₅、T₆时Ⅱ、Ⅲ组凝血功能、血小板聚集功能显著降低（P<0.05）,术后24、48 h切口总引流量明显增加（P<0.01）,术中及术后48 h内输异体血总量明显增加（P<0.01）。结论自体血小板分离联合术中自体血回输可显著改善脊柱侧弯矫形术患者术后血小板聚集及凝血功能,减少术后切口引流量及异体血输注量。

The value of preoperative autologous plateletpheresis in idiopathic scoliosis orthomorphia

Objective To investigate the value of preoperative autologous plateletpheresis combined with intraoperative autotransfusion in idiopathic scoliosis orthomorphia.Methods Sixty patients with undergoing idiopathic scoliosis orthomorphia were randomized into three groups（n = 20）.Group I received preoperative autologous plateletpheresis combined with intraoperative autotransfusion;groupⅡreceived only intraoperative autotransfusion and groupⅢreceived nothing. Coagulation parameters,hemoglobin and hematocrit values,platelet counts and aggregation were evaluated before the anestheria;and 10 min after plateletpheresis,10 min before the infusion of autologous blood or platelet rich plasma,10 min after infusion,24 and 48 h postoperation,Intra-and post-operation blood loss and blood transfusion requirements were recorded.Results Compared with T₁,Plt and the platelet aggregation of all groups were decreased at T₃,T₄（P<0.01）.Compared with groupⅠ,the blood coagulation and the platelet aggregation of the groupsⅡandⅢwere inhibited at 24 and 48 h after operation（P<0.05）,the postoperative blood loss and blood transfusion requirement increased（P < 0.01 ）.Conclusion Preoperative plateletpheresis combined with intraoperative autotransfusion can ameliorate postoperative blood coagulation and the postoperative platelet aggregation of idiopathic scoliosis patients,and then reduce the postoperative bleeding and minimize the need of blood transfusion.