非体外循环下冠状动脉旁路移植术中应用自体血回输对患者术后凝血功能的影响  

Effect of intraoperative cell salvage on coagulation during off-pump coronary artery bypass grafting

作　　者：王森森[1] 沈杰[1] 薛庆生[1] 于布为[1] 

机构地区：[1]上海交通大学医学院附属瑞金医院麻醉科,上海200025

出　　处：《上海医学》2015年第8期662-665,共4页Shanghai Medical Journal

基　　金：卫生行业科研专项资助项目(201002005)

摘　　要：目的前瞻性评价非体外循环下冠状动脉旁路移植术(OPCABG)中应用自体血回输对患者术后凝血功能的影响。方法连续入选OPCABG术中自体血回输的患者46例,美国麻醉医师协会(ASA)分级Ⅰ至Ⅲ级,比较术前和术后24h的凝血功能、血小板计数及其功能、血清肌酐(sCr)水平,计算术后24h引流总量。结果患者术后24h的凝血酶原时间[PT,(13.0±1.0)s]、活化部分凝血活酶时间[APTT,(32.0±3.3)s]、国际标准化比值(INR,1.1±0.1)均较术前[(11.4±0.9)s、(30.2±3.0)s、1.0±0.3]显著升高(P值分别<0.01、0.05),纤维蛋白原水平[(2.6±0.6)g/L]较术前[(3.5±0.6)g/L]显著降低(P<0.01),但均在正常参考范围内。患者术后24h的血小板计数[(150.8±57.5)×109/L]较术前[(179.4±55.9)×109/L]显著减少(P<0.01),手术前后4μmol/L二磷酸腺苷(ADP)诱导的血小板聚集力在1、5min和最大聚集率的差异均无统计学意义(P值均>0.05)。患者术前与术后24h的sCr的差异无统计学意义(P>0.05)。多因素线性回归分析显示,术后24h引流量与自体血回输量无相关性(R=0.056,P=0.711)。结论术中自体血回输不增加OPCABG患者术后的出血风险,对血小板相关的凝血功能无明显影响,但对凝血酶相关凝血功能存在一定的影响。Objective To evaluate the effect of intraoperative cell salvage on coagulation function during off-pump coronary artery bypass grafting （OPCABG） in this prospective study. Methods Forty-six consecutive patients （American Society of Anesthesiologists I-ASA] grade Ⅰ - Ⅲ ）, who received OPCABG with intraoperative cell salvage, were enrolled in the study. The coagulation function, platelet count （PLT） and function, serum creatinine （sCr） level before and 24 hours after surgery were compared. The amount of drainage in 24 hours after surgery was recorded. Results Compared with preoperative ones, prothrombin time （PT, [ 13.0± 1.0] s vs. [ 11.4 ± 0.9] s, P〈0.01 ）, activated partial thromboplastin time （APTT, [32.0 ± 3.3] s vs. [30.2 ± 3.0] s, P〈0.01） and international normalized ratio （INR, 1.1± 0. 1 vs. 1.0 ± 0. 3, P〈0. 05） were significantly increased., while fibrinogen （Fg, [2.6±0.6] g/L vs. [3.5±0.6] g/L, P〈0.01） and PLT （[150.8±57.5] ×10^9/L vs. [ 179.4 ± 55.9] × 10^9/L, P〈0. 01 ） were significantly decreased at 24 h after OPCABG. No significant difference was found in one-, five-minute, maximum 4 μmol/L adenosineediphosphate （ADP）-induced aggregation function of platelet, or sOr level before and after surgery （all P〉0. 05）. Multivariate linear regression revealed there was no correlation between postoperative drainage and cell salvage （R = 0. 056, P = 0.711 ）. Conclusion Intraoperative cell salvage will not increase the risk of postoperative hemorrhage or interfere with the platelet coagulation function in patients undergoing OPCABG, but it may be related to thrombin coagulation function.

关 键 词：自体血回输 非体外循环下冠状动脉旁路移植术 凝血功能 

分 类 号：R614[医药卫生—麻醉学]