自体血小板分离技术对大血管手术凝血指标影响的研究  

Study on the effect of autologous plateletpheresis on parameters of coagulation of vascular surgery

作　　者：樊珍[1] 赵丽云[1] 赵嘉美 侯宇希[1] 马骏[1] 卿恩明[1] 

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

出　　处：《心肺血管病杂志》2017年第9期770-773,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:研究术前自体血小板分离技术(APP)对大血管手术围术期凝血指标的影响,并观察临床效果。方法:选择A型主动脉夹层择期行主动脉替换手术的患者44例,男性36例,女性8例,年龄36~65岁,ASAⅡ-Ⅲ级。根据随机对照原则,将患者分为实验组(A组)与对照组(C组),每组各22例,实验组应用自体血小板分离技术,对照组仅应用血液回收等常规血液保护措施。于麻醉诱导后(T1),鱼精蛋白中和肝素后(T2),术后24h(T3)采集血液标本,监测血小板计数(PLT)、血红蛋白含量(HB)、凝血酶原时间(PT)、活化部分凝血酶时间(APTT)、国际标准比率(INR)、D-二聚体(D-Dimer,DD)、血浆纤维蛋白原(FIB),血栓弹力图(TEG)的反应时间(R)、凝集时间(K)、凝集块形成速率(α-角)、最大振幅(MA)、预测在MA值确定后30min内血凝块溶解的百分比(EPL)。结果:同对照组相比,实验组Plt、MA值在T2、T3时明显升高(P<0.05)。T2时,实验组较对照组APTT明显缩短(P<0.05),R值、K值减小(P<0.05),同时FIB明显增高(P<0.05)。T3时,实验组K值明显小于对照组(P<0.05)。实验组术中异体红细胞输注量、血浆输注量及出血量减少,且止血时间缩短。术后实验组24h引流量减少、机械通气时间以及住院时间均缩短(P<0.05)。结论:APP技术可改善大血管手术术后凝血功能,减少围术期出血量及异体血输注量,具有血液保护作用。Objective： To investigate the effect of autologous plateletpheresis （APP） on perioperative coagulation parameters and clinical effect in patients with vascular surgery. Methods： A total of 44 consecutive patients who received Stanford type A aortic dissection surgery in our hospital were studied, ASA grade from Ⅱ to Ⅲ, aged from 36 to 69 years old. The patients were randomIy divided into two groups： experimental group and control group, the experimental group using autologous plateletpheresis technology, the control group only use other conventional blood protection measures. Blood samples were collected at 3 time points： After induction （T1）, protamine antagonized heparin （T2）, 24 hours after surgery （T3）. Samples were analyzed for platelet count （PLT） ,hemoglobin content （HB） ,prothrombin time （PT） ,activated partial thromboplastin time （ APTT）, international standard ratio （INR） ,D-dimer （ D-D）, plasma fibrinogen （FIB） ,coagulation parameters of thrombelastogram （TEG） （R,K,Ma,α-angle,EPL）. Results： Compared with the C group, Plt and MA value of A group were significantly greater at T2 and T3 （ P 〈 0. 05 ）. While the K value of A group were decreased （ P 〈 0. 05） at T2 and T3. At T2 the FIB of A group was significantly increased （ P 〈 0. 05 ） than C group, the A group K value was significantly less than the control group （ P 〈 0. 05 ）. In the A group, the amount of allogeneic RBC and allogeneic plasma infusion, the drainage volume of perioperative were decreased. The time of mechanical ventilation and time of hospitalization were shortened （ P 〈 0. 05 ）. Conclusion ： Utilization of APP technique can significantly improve the coagulation function of patients with vascular surgery, and reduce the amount of perioperative bleeding and allogeneicblood transfusion.

关 键 词：自体血小板分离技术 大血管手术 凝血功能 

分 类 号：R54[医药卫生—心血管疾病]