自体血小板分离回输对体外循环心脏直视手术患者血液的保护作用  

Reinfusion of autologous platelet-rich plasma during cardiac surgery with cardiopulmonary bypass

作　　者：李沅敏[1] 周健[1] 周耀铨[1] 韩晨俊[1] 仇锋[1] 臧旺福[1] LI Yuan-min ZHOU Jian ZHOU Yao-quan HAN Chen-jun QIU Feng ZANG Wang-fu(Dept. of Cardiovascular Surgery, Tenth People＇s Hospital, Tongji University, Shanghai 200072, Chin)

机构地区：[1]同济大学附属第十人民医院心血管外科,上海200072

出　　处：《同济大学学报（医学版）》2016年第5期44-46,53,共4页Journal of Tongji University(Medical Science)

基　　金：上海市卫生和计划生育委员会项目(201640203)

摘　　要：目的评价自体血小板分离(autologous patelet-richplasma,aPRP)回输对体外循环心脏直视手术患者的血液保护作用。方法选择体外循环心脏直视手术患者90例,将患者随机分为对照组(n=45)和自体血小板分离组(aPRP组,n=45)。aPRP组在麻醉诱导后行血小板分离,在肝素化之前完成富血小板血浆提取,于体外循环结束、鱼精蛋白中和肝素后回输,对照组不行血小板分离。于术前,术后1、24和48 h记录Hb、Plt、PT、APTT及Fib,记录体外循环时间、主动脉阻断时间、术后引流量、输血情况。结果 aPRP组采集并回输富血小板血浆(323±117)ml,Plt分离时间(45±8)min。与对照组比较,aPRP组术后24 h内引流量、输注异体血率下降(P<0.05)。结论自体血小板分离回输可改善体外循环心脏直视手术患者的凝血功能,降低术后出血量和异体血输注,具有血液保护作用。Objective To assess the application of reinfusion of autologous platelet rich plasma （aPRP） in cardiac surgery with cardiopulmonary bypass. Methods Ninety patients undergoing cardiac surgery with cardiopulmonary bypass were assigned to receive aPRP（ n = 45 ） or no to receive aPRP（ n = 45 ）. The plateletpheresis performed before beparinization. Hemoglobin （ Hb ）, platelet （Plt）, prothrombin time （PT）, activated partial thromboplastin time （APTT） and fibrinogen were measured before operation and 1, 24, 48 h after operation. Cardiopulmonary bypass time, aortic crossing time, postoperative drainage volume at 1,24 h after operation and allogeneic blood transfusion volume were recorded. Results In aPRP group, the volume of aPRP reinfused was （ 323 ± 117 ） ml. The plateletpheresis process took （45±8 ）rain. Comparing with control group, the volume of postoperative drainage at 1 and 24 h was significantly reduced in aPRP group. The transfusion rate of packed red blood cells were also reduced in the aPRP group. Conclusion Our results demonstrate that preoperative plateletpheresis and reinfusion can improve the coagulation function of patients undergoing cardiac surgery, and reduce the postoperative blood loss and blood transfusion.

关 键 词：自体血小板分离 血液保护 体外循环 心脏手术 

分 类 号：R654.1[医药卫生—外科学]