自体血小板分离回输对二次瓣膜置换术患者围手术期的影响  

Effectiveness of autologous plateletpheresis during reoperative valve replacement surgery

作　　者：林培容[1] 侯宇希[1] 樊珍[1] 王艳双[1] 赵丽云[1] 

机构地区：[1]首都医科大学附属北京安贞医院麻醉科,北京市100029

出　　处：《中国心血管病研究》2016年第6期540-543,共4页Chinese Journal of Cardiovascular Research

基　　金：北京市科技计划课题基金资助项目（项目编号：Z131107002213134）

摘　　要：目的 探讨自体血小板分离（APP）回输对体外循环下二次瓣膜置换术患者围术期临床预后的影响.方法 选取二次瓣膜置换术患者共40例,男性26例,女性14例,平均年龄（43.2±7.7）岁,随机分为对照组（n=20）和血小板分离组（n=20）.记录所有患者术前LVEF,术中、术后48 h出血量及24 h引流量,术中输血液制品情况,术后瓣膜功能及生存情况,ICU住院时间和总住院时间.结果 ①两组间麻醉诱导前数据,包括人口组成、男女比例及术前心功能均未见统计学差异.②对照组术后瓣膜功能障碍2例,其中1例于术后48 h内死亡,1例接受二次手术,术后情况稳定.血小板分离组患者术后瓣膜功能均良好,术后48 h生存率100％.血小板分离组患者术后24 h引流量、术中及术后48 h出血量较对照组均明显减少（P均＜0.05）,ICU和总住院时间较对照组明显缩短（P均＜0.05）.结论 自体血小板分离能减少体外循环下二次瓣膜置换术患者输血及供体暴露,节约围术期各种异体血液制品的输入,同时可减少围术期相关并发症的发生,改善患者预后,总体上缩短患者的住院时间.Objective The purpose of this study was to evaluate the effectiveness of autologous platelet- phresis （APP） during reoperative valve replacement surgery. Methods 40 consecutive patients [26 males and 14 females, mean age（43.2＋7.7）years ] undergoing cardiopulmonary bypass valve re-replacement were enrolled in this prospective, randomized trial. The patients were randomized into two groups： autologous plateletphresis group （n= 20） and control group（n=20）. Preoperative LVEF, perioperative, 48 h postoperative bleeding volume and transfu- sion needs, 24 h drainage postoperative valve dysfunction, length of postoperative intensive care unit stay and hos- pital stay were recorded. Results （1）There were no significant differences in base line data between two groups. （2）In control group, valve dysfunction was appeared in 2 cases, including 1 case died within 48 h after operation, 1 case received reoperation and postoperative conditions were stable. In APP group, valve function was good in all patients, and the survival rate of 48 h was 100%. In all analyses, prognostic indicators including 24 h induced flow, intraoperative and postoperative 48 h bleeding volume, length of postoperative intensive care unit stay and hospital stay were significantly improved in APP group. Conclusion The APP technique has bIood-saving effect in patients undergoing cardiopulmonary bypass valve reoperation.

关 键 词：血小板分离 二次瓣膜置换术 体外循环 

分 类 号：R654.2[医药卫生—外科学]