心脏外科手术中等容血液稀释与富血小板分离在体外循环血液保护的对比研究  

Comparison of platelet-rich plasma sequestration and acute normovolemic hemodilution on blood preservation incardionpulmonary bypass blood protection in cardiac surgery

作　　者：刘炜[1] 余琼[1] 张翠荣 饶美英[3] 唐燕华[4] 董啸[4] 徐建军[4] LiuWei;Yu Qiong;Zhang Cuirong;Rao Meiying;Tang Yanhua;Dong Xiao;Xu Jianjun(Operating room of the Second Affiliated Hospital of Nanchang University,Nanchang,Jiangxi,330006China;Department of Acupuncture and Moxibustion,Affiliated Hospital of Jiangxi University of Traditional Chinese Medicine,Nanchang,Jiangxi,330006China;Department of Blood Transfusion,the Second Affiliated Hospital of Nanchang University,Nanchang,Jiangxi,330006China;Department of Cardiac Macrovascular Surgery,the Second Affiliated Hospital of Nanchang University,Nanchang,Jiangxi,330006China)

机构地区：[1]南昌大学第二附属医院手术室,江西南昌330006 [2]江西中医药大学附属医院针灸科,江西南昌330006 [3]南昌大学第二附属医院输血科,江西南昌330006 [4]南昌大学第二附属医院心脏大血管外科,江西南昌330006

出　　处：《当代医学》2019年第24期16-19,共4页Contemporary Medicine

基　　金：江西省重点研发计划项目(2016BBG70226)

摘　　要：目的比较富含血小板血浆分离与急性等容血液稀释对心脏外科手术体外循环患者的血液效果的研究。方法60例在ECC下行心内直视术患者随机分成3组,Ⅰ组(进行PRP分离)经颈静脉采集自体行PRP分离,分离贫血小板和红细胞立即回输患者体内,PRP等体外循环结束后回输;Ⅱ组(不进行PRP分离)经颈静脉放血待体外循环后回输体内;Ⅲ组不进行上述任何血液保护措施,分别在麻醉诱导后即刻(T1),采血后10 min(T2),ECC开放后10 min(T3),输自体血后10 min(T4),患者出手术室时(T5),术后24 h(T6)6个时间点抽取血标,测定红细胞比容(Hct)、血小板计数(Pit)、凝血酶原时间(PT)、部分凝血活酶时间(APTT)、纤维蛋白原(FIB);栓弹力图(TEG)和血小板功能(PLT)分析仪,测定T1和T5两个时间点的凝血速率(CR)和血小板功能(PF)。结果Hct值:3组各个时间与T1相比,T2、T3均降低(P<0.05或P<0.01),但Ⅰ组T2下降不明显;3组组间比较,Ⅰ组T2、T3比Ⅱ组高(P<0.05或P<0.01),与Ⅲ组比较差异无统计学意义。Pit值:3组各时间与T1比较均降低(P<0.05或P<0.01);3组组间比较,T1和T6时差异无统计学意义,T2和T3时Ⅰ组低于Ⅱ组,Ⅱ组低于Ⅲ组(P<0.05),T4时Ⅰ组显著高于Ⅱ组和Ⅲ组(P<0.01)。CR和PF:Ⅰ组T5时恢复至T1水平,Ⅱ组T5时较T1时显著降低(P<0.01);Ⅲ组T5时较T1显著降低(P<0.01)。Ⅰ组T6时胸引量和红细胞输入量显著少于Ⅱ、Ⅲ组。结论富含血小板血浆分离比急性等容血液稀释对心脏外科手术体外循环患者具有更有效的血液保护,急性等容性血液稀释(ANH)比不进行上述任何血液保护措施,可减少血液有型成分及血浆凝血因子的破坏,可以明显减少围手术期的异体血制品用量。而且栓弹力图(TEG)能够检测体外循环后凝血功能的变化,对心脏手术患者术后异常出血原因及指导合理使用血制品具有重要价值。Objective To compare blood preservation effect of platelet-rich plasma sequestration(PRPS)and acute normovolemic hemodilution(ANH)incardionpulomnary with extracorporeal circulation(ECC).Methods 60 consecutive patients who were to undergo incaedionpulmonary with ECC were randomly divided into PRPS(Ⅰ)group and ANH(Ⅱ)group andⅢgroup.InⅠgroup,blood was removed via right internal jugular after induction of anesthesia and was separated into platelet–poor plasma(PPP),PRP and blood cell by a cell saver(electa,Sorin Group,Italy).PPP and blood cell were rein-fused back to the patients immediately.PRP was rein-fused after ECC.In groupⅡ,blood removal was performed via right internal jugular after anesthesia.The blood was rein-fused to the patient after ECC.In groupⅢ,never blood protection.Hb and Plt were measured after induction(T1),10 min after blood collection(T2),10 min after ECC onset(T3),transfusion of autologous blood for 10 min(T4),after operation(T5)and 24 h after operation(T6).Clot rate(CR)and platelet function(PF)were analyzed at T1 and T5 with Sonoclot analyzer(Becton-Dickison,USA).Results Compared with T1,T2 and T3 in each of the three groups Hct significantly decreased(P<0.05 or P<0.01)but in groupⅠ,T2 did not decreased significantly.T2,T3 in groupⅠwas higher than groupⅡ(P<0.05 or P<0.01),and no difference was found with groupⅢ.In three groups,Pit decreased at T2、T3、T4、T5 and T6 compared with T1(P<0.05 or P<0.01).At T2,T3,Pit in groupⅠwas decreased than groupⅡ,Pit in groupⅡwas decreased than groupⅢ(P<0.05).At T4,Pit in groupⅠwas significantly higher than groupⅡand groupⅢ(P<0.01).In groupⅠ,CR and PF at T5 were same T1.At T5 CR and PF in groupⅡand groupⅢwere significantly decreased than at T1(P<0.01).The 24 h mediastinal drainage volume was lower significantly in groupⅠthan in groupⅡand in groupⅢ.Conclusion PRPS to cardiac surgery is more effective than ANH conservation,ANH than to any of these measures,can reduce blood visible part and destruction of the plasm

关 键 词：体外循环 心脏手术 等容血液稀释 富血小板分离 血液保护 

分 类 号：R65[医药卫生—外科学]