血小板分离联合术中自体血回收对骨科大手术减少失血和血小板活化的影响  

Efficacy of platelet-plasmapheresis combined with intraoperative blood salvage in major orthopedic surgery

作　　者：黄长顺[1] 陈春茹[1] 张益维[1] 陈益君[1] 桂煜[2] 李满新[2] 严敏[3] 

机构地区：[1]宁波市第一医院麻醉科,315010 [2]宁波大学医学院附属医院麻醉科 [3]浙江大学医学院附属第二医院麻醉科

出　　处：《浙江医学》2012年第14期1202-1205,1209,共5页Zhejiang Medical Journal

基　　金：宁波市择优社会发展科技项目基金（2009C50003）;浙江省公益性技术应用研究计划项目基金（2011C33054）;卫生部科研基金省部共建基金（WKJ2008-2-021）

摘　　要：目的探讨血小板分离联合术中自体血回收对骨科大手术节约用血和血小板活化的影响。方法150例择期行骨科大手术的息者（估计术中出血量≥800m1），随机分为3组，每组50例。Ⅰ组进行自体血小板分离和术中自体血回收，术中分别予以回输；Ⅱ组只进行自体血回收，不进行血小板分离，术中予以回输；Ⅲ组为对照组，不进行上述任何血液保护措施，按需输注异体血。测定各组患者5个时间点的凝血酶原时间（PT）、部分凝血活酶时间（APTT）、血栓弹力图（TEG）的凝血功能参数[包括反应时间（R）、凝血时间（K）、a角、最大振幅（MA）和凝血指数（C1）]及血小板PAC-1、CD62P和CD63的表达量。结果术中Ⅰ、Ⅱ两组均未输注异体血，Ⅲ组输注异体红细胞悬液（2±1）U；术后Ⅰ组未输注异体血，Ⅱ组、Ⅲ组输注异体血比例分别为30％[15／50）和32％（16／50）。3组间PT、APTT变化差异均无统计学意义（均P〉O．05）。Ⅰ组术后CD62P表达低于麻醉诱导前和输注自体富血小板血浆前（P〈0，05）。与Ⅰ组比较，术后Ⅱ组、Ⅲ组的MA值呈下降明显（P〈0．05），而CD62P表达明显升高（P〈0．05）。3组间PAC-1、CD63表达差异均无统计学意义（均P〉0．05）。结论术中自体血回收可以减少术中用血但不能减少术后出血和输血。血小板分离不会引起血小板活化。并在一定程度上保护血小板的功能，可以起到减少术后出血及节约用血的效果。Objective TO evaluate the application of platelet-plasmapheresis with intraoperative blood salvage in major orthopedic surgery. Methods One hundred and fifty patients scheduled for elective major orthopedic surgery （estimated blood loss ≥ 800ml）,were randomly divided into three groups （n=50 in each）. In group A, blood was withdrawn after induction of anes- thesia, to sequester the platelet rich plasma （PRP） which was re-infused. An autotransfusion device was used to collect and re-infuse autologous RBC during the course of the operation in both groups A and B, while an allogenic blood transfusion was conducted in group C as a control. Prothrombin time （PT）, activated partial thromboplastin time （aP＇FI＇）, thrombelastogram （TEG） parameters reaction time （R）, clotting time （K）, angle co, maximum amplitude （MA） and coagulation index （CI））, and expression of PAC-1, CD62P, CD63 on platelet were detected at five different time points. Results There was no intraoperative allogenic blood transfusion in both groups A and B, while 2 ＋ 1 units of allogenic erythrocyte suspension were infused in group C. The postoperative allogenic blood transfusion rates were 0% （0/50）, 30%（ 15/50）and 32%（ 16/50 }in groups A, B and C respectively. In group A, the expression of CD62P was not increased after operation. The postoperative MA values were decreased but the ex- pression of CD62P was up-regulated in both groups B and C compared to group A （P〈0.05）. There were no significant differences in PT, aPTT, expression of PAC-1 or CD63 among all groups. Conclusion Intraoperative blood salvage can reduce allogenic blood transfusion during surgery rather than reducing postoperative hemorrhage or blood transfusion. Platelet-plasmapheresis does not trigger platelet activation, but protects its action to a certain extent, which might decrease the risk of postoperative bleeding and reduce the blood translation.

关 键 词：血小板分离 自体输血 血小板活化 骨科手术 

分 类 号：R457.1[医药卫生—治疗学]