血栓弹力图评价自体血小板分离术对心脏手术患者血小板活化状态及功能的影响  

Study on the evaluation of elastic diagram of thrombus in acute autologous platelet isolation in platelet activation and activation in different stages of cardiac surgery

作　　者：赵骥[1] 王松[1] 徐宗风 高长杰[1] 

机构地区：[1]胜利油田中心医院,山东东营257034

出　　处：《中国输血杂志》2017年第11期1262-1264,共3页Chinese Journal of Blood Transfusion

摘　　要：目的探讨血栓弹力图(TEG)及流式细胞术评价术前急性自体血小板分离对心脏手术患者不同阶段凝血功能及血小板活化状态。方法选择心血管外科心脏手术患者36例,按随机数字表法分组,对照组18例予以急性等容血液稀释(ANH)联合术中自体血回输给患者,研究组18例予以ANH联合自体富血小板血浆(APRP)及术中自体血回输给患者。分别于肝素化前(T1)、术后l h(T2)和24 h(T3)时应用TEG测定凝血功能参数及应用流式细胞术检测血小板活化指标PAC-1和CD62。结果 2组患者治疗不同时间点凝血指标均发生变化,研究组围术期T3时间点PT、APTT分别为[(13.21±1.59,31.11±4.21)s]明显低于对照组,Fib为2.99±0.61 g/L显著高于对照组;研究组围术期T3时间点的R、K分别为[(5.42±2.01,2.12±0.49)min]显著低于对照组,a角、MA分别为[(44.67±6.72),63.75±6.42)mm]显著高于对照组(P<0.05);研究组围术期T2、T3时间点PLT、PAC-1和CD62P分别为[(135.23±34.41)×109/L,(13.57±0.86,4.41±1.29)%和(148.23±35.59)×109/L,(15.81±1.23,4.35±1.21)%]与对照组比较,P>0.05。结论自体血小板在心脏手术围术期发挥了明显的改善患者凝血功能的作用,通过TEG参数评价术前自体血小板分离回输患者围术期的凝血功能,比流式细胞术检测血小板活化功能更具优势和意义。Objective To investigate the evaluation of elastic diagram of thrombus in acute autologous platelet isolation in platelet activation and activation at different stages of cardiac surgery. Methods 36 cases of cardiovascular surgery were selected,and according to a random number table they were divided into two groups： control group（ n = 18） was treated with acute volume hemodilution（ ANH） combined with intraoperative autologous blood transfusion; study group（ n = 18） was treated with ANH combined with autologous rich platelet rich plasma（ APRP） and intraoperative autologous blood transfusion. The parameters of coagulation function and platelet activation function were detected by elastic diagram of thrombus at before anesthesia induction（ T1）,pre heparin（ T2）,postoperative LH（ T3）,24 h（ T4） and 48 h（ T5）. Results APTT and PT in the study group at the perioperative period of T4,T5 were lower,K and R in the study group were lower,a angle and MA index were higher（ P〈0. 05）. Platelets,PAC-1,CD62 P,and CD63 in two groups had no statistical difference at each time point（ P〉0. 05）. Conclusion The evaluation of preoperative autologous platelet transfusion combined with autologous blood recovery can significantly improve the coagulation function of patients with cardiac surgery,and has little effect on platelet activation function.

关 键 词：血栓弹力图 急性自体血小板分离 心脏手术 血小板活化状态及活化功能 

分 类 号：R457.1[医药卫生—治疗学] R825.4[医药卫生—临床医学]