自体血小板分离技术对深低温停循环主动脉手术患者血液保护作用的Meta分析  

Blood conservation effect of autologous plateletpheresis in patient undergoing aortic surgery with deep hypothermic circulatory arrest:A Meta-analysis

作　　者：白松杰 张莉[1] 曾冰 黄志勇 BAI Song-Jie;ZHANG Li;ZENG Bing;HUANG Zhi-Yong(School of Clinical Medicine,University of South China,Hengyang 421001,China;Department of Anesthesiology,Fmvai Hospital Chinese Academy of Medical Sciences,Shenzhen 518000,China)

机构地区：[1]南华大学临床医学院,湖南省衡阳市421001 [2]中国医学科学院阜外医院深圳医院麻醉科

出　　处：《中国心血管病研究》2019年第12期1143-1148,共6页Chinese Journal of Cardiovascular Research

基　　金：深圳市科创委知识创新计划基础研究项目(JCYJ20170307161610240)~~

摘　　要：目的系统评价自体血小板分离技术(APP)对深低温停循环(DHCA)主动脉手术患者的血液保护作用。方法检索PubMed、Embase、Cochrane Library、中国生物医学文献数据库、中国知网、万方数据库和维普数据库,时间均从建库至2019年7月,收集APP应用于DHCA主动脉手术患者的随机对照试验(RCT)。采用RevMan5.3软件进行Meta分析。结果共纳入6篇RCT,共计464例患者。Meta分析结果显示,与对照组相比,APP组术中异体红细胞(RBC)(MD=-1.02,95%CI-2.69~0.64,P=0.23)、血小板(PLT)(MD=-3.74,95%CI-7.77-0.29,P=0.07)输注量减少,比较差异无统计学意义;术中新鲜冰冻血浆(FFP)(MD=-320.53,95%CI-588.74^-52.31,P=0.02)、冷沉淀(CP)(MD=-3.50,95%CI-4.33^-2.67,P<0.00001)输注量明显减少,差异有统计学意义;术后异体RBC(MD=-1.74,95%CI-2.50^-0.99,P<0.00001)、FFP(MD=-182.51,95%CI-204.91^-160.11,P<0.00001)、CP(MD=-1.92,95%CI-2.57^-1.27,P<0.00001)、PLT(MD=-3.06,95%CI-5.81^-0.32,P=0.03)输注量明显减少,差异有统计学意义;术中出血、术后24h引流量、机械通气时间、ICU住院时间及总住院时间明显减少(P<0.05);住院期间病死率、术后急性肺损伤、术后急性肾损伤和术后血液滤过率比较差异无统计学意义。结论APP可以显著减少DHCA主动脉手术患者围术期异体输血量,是一项有效的血液保护措施,但上述结论仍需更多高质量的研究予以证明。Objective To systematically review the blood conservation effect of autologous plateletpheresis in patient undergoing aortic surgery with deep hypothermic circulatory arrest.Methods The PubMed,Embase,Cochrane Library,CBM,CNKI,Wanfang and VIP databases for all randomized controlled trials(RCTs)in which aortic surgery patients with deep hypothermic circulatory arrest(DHCA)were randomly assigned to autologous plateletpheresis(APP)or conventional blood conservation were researched.Meta-analysis was conducted using the Cochrane Collaboration’s RevMan5.3 software.Results A total of 464 patients from 6 trials were subjected to Meta-analysis.In comparison with the control group,the APP group required fewer operative transfusions:red blood cell(MD=-1.02,95%CI-2.69-0.64,P=0.23),platelet(MD=-3.74,95%CI-7.77-0.29,P=0.07),fresh frozen plasma(MD=-320.53,95%CI-588.74--52.31,P=0.02),cryoprecipitate(MD=-3.50,95%CI-4.33--2.67,P<0.00001)and fewer postoperative transfusions:red blood cell(MD=-1.74,95%CI-2.50--0.99,P<0.00001),fresh frozen plasma(MD=-182.51,95%CI-204.91--160.11,P<0.00001),platelet(MD=-3.06,95%CI-5.81-0.32,P=0.03),cryoprecipitate(MD=-1.92,95%CI-2.57--1.27,P<0.00001).Intraoperative bleeding,postoperative 24-hour drainage,mechanical ventilation time,intensive care length of stay and length of total hospital stay were significantly reduced(P<0.05).There was no significant difference in mortality during hospital stay,acute lung injury,acute renal injury and hemofiltration rate.Conclusion Autologous plateletpheresis can reduce perioperative allogeneic blood transfusion in aortic surgery patients with deep hypothermic circulatory arrest,which is an effective blood conservation strategy.However,it needs to be verified by more high quality researches.

关 键 词：自体血小板分离技术 自体富血小板血浆 血管外科手术 主动脉手术 深低温停循环 血液保护 META分析 

分 类 号：R654.2[医药卫生—外科学]