自体血小板分离技术用于心脏瓣膜手术的前瞻随机对照研究  

Autologous Plateletpheresis in Cardiac Valvular Surgery: A Prospective Randomized Controlled Study

作　　者：石晟[1] 王古岩[1,2] SHI Sheng;WANG Gu-Yan(Department of Anesthesiology,Fuwai Hospital,National Center for Cardiovascular Diseases,CAMS and PUMC,Beijing 100037,China;Department of Anesthesiology,Tongren Hospital,Capital Medical University,Beijing 100730,China)

机构地区：[1]北京协和医学院国家心血管病中心中国医学科学院阜外医院麻醉中心,北京市100037 [2]首都医科大学附属,北京市100730

出　　处：《中国分子心脏病学杂志》2019年第4期2976-2979,共4页Molecular Cardiology of China

基　　金：术中自体血小板分离对心脏手术的血液保护作用(2014-ZX002)

摘　　要：目的探讨自体血小板分离技术在心脏瓣膜手术中的血液保护作用和对短期临床结局的影响。方法纳入2014年8月至2016年5月择期行全麻低温体外循环心脏瓣膜手术的患者208例,随机分为两组。试验组(n=102):行自体血小板分离术联合自体血液回收技术;对照组(n=106):单纯行术中自体血液回收技术。主要观察指标为术后24h胸液引流量。同时记录两组患者的手术时间、体外循环时间、最低直肠温、术中补液量、术后胸液量、异体血液制品输注率和量、术后机械通气时间、ICU停留时间、并发症发生率和死亡率等。于术前(T1)、术毕(T2)及术后24h(T3)测定血常规、凝血酶原时间(PT)、活化部分凝血酶原时间(APTT)及血栓弹力图(TEG)。结果试验组与对照组术后24h胸液引流量无统计学差异[(543.7±331.5)mlvs(520.9±363.8)ml,P=0.638]。试验组手术时间少于对照组[(201.5±35.7)minvs(213.8±38.2)min,P=0.017],但术中补液量增加,具有统计学差异(Pv0.05)。其余实验室和临床指标两组间无差别。结论在心脏瓣膜手术中应用自体血液回收技术的同时应用术前自体血小板分离未能降低术后24h的胸液引流量。Objective To quantify the effect of blood conservation and short-term clinical outcomes of autologous plateletpheresis in patients undergoing cardiac valvular surgery. Methods We randomly assigned 208 patients undergoing elective cardiac valvular surgery to receive either cell salvage and autologous plateletpheresis (n=102) or only cell salvage (n=106) from August 2014 to May 2016. The primary endpoint was the chest tube drainage of 24 hours postoperatively. The duration of the operation and cardiopulmonary bypass (CPB), the lowest rectal temperature, the volume of liquid infusion, the chest tube drainage postoperatively, allogeneic transfusion, the duration of mechanical ventilation, the length of the postoperative ICU stay, the morbidity and the mortality were recorded in both groups. Routine blood test, PT, APTT and TEG were measured in T1 (the beginning of surgery), T2 (the end of surgery) and T3(24 hours after surgery). Results There was no significant difference in chest tube drainage of 24 hours postoperatively between two groups ([543.7±331.5]ml vs [520.9±363.8]ml, P=0.638). The duration of the operation was reduced ([201.5±35.7] min vs [213.8±38.2]min, P=0.017) and the volume of liquid infusion was increased (P<0.05) in the trail group. Other laboratory and clinical outcomes were similar between groups. Conclusion Autologous plateletpheresis will not reduce the chest drainage of 24 hours postoperatively during the cardiac valvular surgery, when cell salvage is used simultaneously.

关 键 词：自体血小板分离 自体血回收 心脏瓣膜手术 血液保护 

分 类 号：R654.2[医药卫生—外科学]