术前自体血小板分离在心血管手术中的应用——来自中国医学科学院阜外医院70例患者的治疗经验  

Preoperative Autologous Plateletpheresis in Cardiac Surgery-70 Cases Experiences In FuWai Hospital

作　　者：石晟[1] 王古岩[1,2] SHI Sheng;WANG Gu-yan(Department of Anesthesiology,Fuwai Hospital,Chinese Academy of Medical Sciences,Peking Union Medical College, National Center for Cardiovascular Diseases,State Key Laboratory of Cardiovascular Disease,Beijing 100037,China)

机构地区：[1]北京协和医学院国家心血管病中心心血管疾病国家重点实验室中国医学科学院阜外医院麻醉科,北京市100037 [2]首都医科大学附属北京同仁医院麻醉科,北京市100730

出　　处：《中国分子心脏病学杂志》2018年第6期2678-2681,共4页Molecular Cardiology of China

基　　金：中国医学科学院医学与健康科技创新工程(2017-I2M-3-003)

摘　　要：目的通过回顾性分析术前实施自体血小板分离的心血管手术患者的围术期临床资料,总结该技术的操作要点和患者麻醉管理经验。方法纳入2014年8月至2016年8月在我院本部实施术前自体血小板分离的全部心血管手术患者,记录血小板分离操作的相关数据、患者麻醉管理方法及患者围术期临床资料,进行回顾性分析总结。结果共纳入70例患者,其中大血管手术患者15例,心脏瓣膜手术患者46例,大血管合并瓣膜手术患者9例。分离所得富血小板血浆量为(182.3±74.3)ml,总操作时间为(26±11.3)min,术后24小时胸液量为(500±360.4)ml。70例患者中,输注异体血液制品35例(50%),二次开胸止血4例(5.7%),肾脏替代治疗3例(4.3%),死亡1例(1.4%)。结论术前自体血小板分离作为一种新的血液保护方法,可由经验丰富的麻醉医生,运用于心血管手术中。Objective This study retrospectively analyzed the perioperative clinical data among patients receiving perioperative autologous plateletpheresis in cardiovascular surgery, and summarized the technical points and the characteristics of anesthetic management. Method We reviewed all patients undergoing cardiovascular surgery and receiving perioperative autologous plateletpheresis in our hospital from August 2014 to August 2016. All technical data and perioperative clinical data were recorded and analyzed. Result A total of 70 patients were enrolled. 46 patients underwent cardiac valve surgery, 15 patients underwent major vascular surgery, 9 patients underwent both. Volume of platelet-rich plasma(PRP) retransfused was 182.3±74.30 ml. Time of PRP harvest procedure was 26±11.28 min. The chest drainage in 24 hours postoperatively was 500±360.39 ml. In all patients, 35 cases required allogeneic blood products transfusion(50%), 4 cases needed re-operation for bleeding(5.7%), 3 cases required renal replacement treatment(4.3%), and 1 case was dead(1.4%). Conclusions Preoperative autologous plateletpheresis is a new method for blood conservation. This technique can be applied to cardiovascular surgery by experienced anesthesiologists.

关 键 词：自体血小板分离 心血管手术 血液保护 麻醉管理 

分 类 号：R654.2[医药卫生—外科学]