自体血小板分离回输对复杂主动脉弓部手术患者围术期全身炎性反应的影响  

Influence of autologous plateletpheresis on systemic inflammatory response after complex aortic arch surgery

作　　者：林培容[1] 侯宇希[1] 赵嘉美 樊珍[1] 赵丽云[1] 马骏[1] 

机构地区：[1]首都医科大学附属北京安贞医院-北京市心肺血管疾病研究所麻醉科,100029

出　　处：《心肺血管病杂志》2016年第6期449-452,共4页Journal of Cardiovascular and Pulmonary Diseases

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

摘　　要：目的：探讨自体血小板分离（a PRP）回输,对复杂主动脉弓部手术患者围术期全身炎性反应的影响。方法：选择A型主动脉夹层行＂象鼻术＂及全弓置换术患者41例,随机将患者分为对照组（n=11）和血小板分离组（n=30）,于麻醉诱导前（T1）、血小板分离后（T2）、离开手术室前（T3）及术后24h（T4）记录两组患者白细胞介素-6（IL-6）、白细胞介素-8（IL-8）、白细胞介素-10（IL-10）及肿瘤坏死因子-α（TNF-α）等炎性因子指标及Hb和血小板数等指标。同时记录患者CPB运转时间,术前左心室射血分数（LVEF）,术中血浆输注量,术中出血量,ICU停留时间和住院时间。结果：两组患者麻醉诱导前人口组成、男女比例及术前心功能,均差异无统计学意义;两组患者T1-T4时,Hb与Plt呈逐渐降低趋势,差异有统计学意义（P=0.000）;T2点,实验组Plt显著高于对照组（P=0.004）,其余时间点差异无统计学意义,各时间点两组间Hb差异均无统计学意义。实验组和对照组离室前（T3）及术后24h（T4）血浆IL-6、8及TNF-α浓度等指标较麻醉诱导前（T1）呈逐渐下降趋势,离室前至术后24h,实验组血浆IL-8浓度较对照组显著降低,差异有统计学意义（P〈0.01）,两组间IL-10血浆浓度变化不显著。实验组术中平均出血量、24h胸腔引流量、ICU停留时间及住院时间均明显少于对照组（均P〈0.01）。结论：主动脉弓部手术患者,自体血小板分离（aPRP）能减少输血量,并可以降低术后炎性介质水平,减轻炎性反应,从而减少术后并发症,降低患者的住院时间,降低医疗费用。Objective：The purpose of this study was to evaluate the effectiveness of autologous platelet-rich plasma （aPRP） as a new blood conservation technique to reduce inflammatory reaction in aortic arch surgery with deep hypothermic circulatory arrest （DHCA）. Method： 41consecutive type-A aortic dissections patients undergoing frozen elephant trunk with total arch replacement （Bentall plus Sun＇s surgery） were enrolled in this prospective, randomized trial. The patients were randomized into two groups： regular blood conservation group （ n = 11 ） and autologous platelet-rich plasma group （ n = 30）. Perioperative transfusion needs, laboratory examination （including IL-6,8,10 ,TNF-oL）and length of postoperative intensive care unit stay and hospital stay were analyzed. Results： There were no significant differences in base line data between two groups. The con- centration both of Hb and Pit tend to be significantly lower in two groups from T1 to T4 （ P = 0. 000 ） ; In T2, the Ph concentration in APPgroup is significantly lower than control group（ P = 0. 004）. IL-6,8 and TNF-α plasma concentration tend to be non-significantly decreased between two groups, and there was a statistically decrease of IL-8 plasma concentration in 24 hours after surgery. In all analyses, prognostic indicators （intraoperative bleeding volume, 24 hours drainage volume, intensive care unit stay and hospital stay） were significantly improved in aPRP group. Conclusion： The utilization of autologous platelet-rich plasma might reduce inflammato- ry reaction in early postoperative stage and was associated with a decrease in early postoperative complications.

关 键 词：自体血液回输 炎性反应 主动脉弓部手术 深低温停循环 

分 类 号：R54[医药卫生—心血管疾病]