术前自体血小板分离对复杂成人先天性心脏病手术的血液保护效果  

Effect of preoperative autologous plateletpheresis on blood conversation in complex surgery for patients with adult congenital heart disease

作　　者：雷迪斯[1] 曾琳玲 巫红梅[2] 章晓华[1] 陈星[1] 黄志锋[2] 陈寄梅[1] LEI Di-si;ZENG Lin-ling;WU Hong-mei;ZHANG Xiao-hua;CHEN Xing;HUANG Zhi-feng;CHEN Jimei(Department of Cardiac Surgery,Guangdong Cardiovascular Institute,Guangdong Provincial Peoples's Hospital,Guangdong Academy of Medical Sciences,Guangdong Provincial Key Laboratory of South China Structural Heart Disease,Guangzhou 510100,China;Department of Burn,Guangdong General Hospital,Guangdong Academy of Medical Sciences,Guangzhou 510100,China)

机构地区：[1]广东省心血管病研究所心外科,广东省人民医院(广东省医学科学院),广东省华南结构性心脏病重点实验室,广州510100 [2]广东省人民医院烧伤科,广州510100

出　　处：《岭南心血管病杂志》2020年第3期292-296,共5页South China Journal of Cardiovascular Diseases

基　　金：广东省医学科学技术研究基金(项目编号:A2018460);广东省科技计划项目(项目编号:2019B020230003);广东省医学科研基金(项目编号:A2017004)。

摘　　要：目的探讨术前自体血小板分离(autologous plateletpheresis,APP)对体外循环(cardiopulmonary bypass,CPB)下复杂成人先天性心脏病手术的血液保护效果。方法回顾性分析2018年6月至2019年9月在广东省人民医院住院,CPB下行复杂成人先天性心脏病矫治手术的患者的临床资料。使用APP技术的患者20例为APP组,根据术式配对同期未使用APP技术的手术患者20例为对照组。APP组分离的贫血小板血浆和红细胞酌情按需回输,富血小板血浆在CPB结束后并且鱼精蛋白完全中和后予以回输。收集围术期临床数据,血制品使用量和预后情况,凝血指标以及血栓弹力图(thromboelastogram,TEG)数据。结果两组患者术前年龄、体质量、性别比较,差异无统计学意义(P>0.05)。两组患者手术类型大致相同、再次手术比例均为50%。两组患者的CPB时间、主动脉阻断时间、术后24 h胸液量、机械通气时间、重症监护病房(intensive care unit,ICU)停留时间、病死率比较,差异无统计学意义(P>0.05)。APP组患者异体血小板的输注率(5%vs.35%,P<0.05)和输注量[0(0~0)vs.0(0~1),P<0.05]少于对照组,差异有统计学意义。APP组异体红细胞的输注率(10%vs.45%,P<0.05)和输注量[0(0~0)vs.0(0~2.8),P<0.05]比较,差异有统计学意义。两组患者的围术期凝血指标比较,差异无统计学意义(P>0.05)。TEG结果中除APP组在CPB结束后最大血块强度较对照组小外,两组患者其他指标比较,差异无统计学意义(P>0.05)。结论术前自体血小板分离技术在复杂成人先天性心脏病手术中应用,可在减少异体血小板输注的同时不影响凝血功能,并可减少异体红细胞的使用,起到血液保护的作用。Objectives To investigate the effect of preoperative autologous plateletpheresis(APP)on blood conversation in complex surgery under cardiopulmonary bypass(CPB)for patients with adult congenital heart disease.Methods From June 2018 to September 2019,characteristic of patients underwent complex surgery for adult congenital heart disease under cardiopulmonary bypass were retrospectively analyzed.Twenty patients with APP were included in APP group,and 20 patients without APP were matched according to the operation types as control group.Platelet-poor plasma and red blood cells got by APP were reinfused as and when required,while platelet-rich plasma was reinfused after protamine reversal of heparin.Perioperative clinical data,blood product usage and prognosis,blood coagulation index and thromboelastogram(TEG)were collected.Results There were no significant differences in age,weight and gender between the two groups(P>0.05).There were no significant differences between the two groups in durations of CPB,cross-clamping,mechanical ventilation and 24 hours postoperative dranage volume,length of stay in the intensive care unit(ICU).There were no in-hospital deaths in APP group,while one patient in control group died of multiple organ failure.The infusion rate(5%vs.35%,P<0.05)and volume[0(0~0)vs.0(0~1),P<0.05]of allogeneic platelets in APP group were significantly lower than those in control group.The infusion rate(10%vs.45%,P<0.05)and volume[0(0~0)vs.0(0~2.8),P<0.05]of erythrocytes in APP group were also significantly lower than those in control group.There was no significant difference in perioperative coagulation indexes between the two groups(P>0.05).There was no significant difference in perioperative TEG results between the two groups,except that post-CPB maximal amplitude(MA)was smaller in APP group.Conclusions Preoperative autologous plateletpheresis is useful in the complex surgery for patients with adult congenital heart disease.It could reduce allogeneic platelet infusion without affecting the coagulation functi

关 键 词：成人先天性心脏病 血小板分离 血液保护 

分 类 号：R541.1[医药卫生—心血管疾病]