不同自体血小板分离量对中低温停循环急性主动脉夹层手术患者肺功能的影响  

Effect of different volume of autologous platelet separation on lung function in patients undergoing acute aortic dissection surgery with moderate hypothermia circulatory arrest

作　　者：裴馨[1] 何琛[1] 谢思远 蔡成惠 马骏[1] 赵丽云[1] PEI Xin;HE Chen;XIE Siyuan;CAI Chenghui;MA Jun;ZHAO Liyun(Department of Anesthesia Center,Beijing Anzhen Hospital,Capital Medical University,Beijing Institute of Heart,Lung and Blood Vessel Diseases,Beijing 100029,China)

机构地区：[1]首都医科大学附属北京安贞医院-北京市心肺血管疾病研究所麻醉科,100029 [2]首都儿科研究所附属儿童医院麻醉科

出　　处：《心肺血管病杂志》2021年第9期940-944,950,共6页Journal of Cardiovascular and Pulmonary Diseases

摘　　要：目的:分析自体血小板分离(APP)技术中不同自体血小板分离量对中低温停循环(MHCA)下急性主动脉夹层手术肺功能相关指标的影响。方法:对经历MHCA下实施主动脉根部替换(Bentall)加全主动脉弓替换及支架象鼻植入术(孙氏手术)的急性主动脉A型夹层患者进行回顾性分析。根据入选/排除标准选择病例,并依据自体血采血量分为A组(<15 mL/kg)、B组(15~20 mL/kg)、C组(>20 mL/kg)。收集患者入手术室前(T1)、回监护室1 h(T2)、术后24 h(T3)、术后48 h(T4)各时间点的动脉血气结果,计算氧合指数(OI)、呼吸指数(RI)及肺泡-动脉氧分压差[P(A-a)DO2],对比分析三组肺功能相关指标的差异,分析术中出血量、术后24 h引流量、围术期异体血输注情况、手术时间、体外循环时间、阻断及停循环时间、术后带管时间、ICU停留时间及住院时间的差别。结果:最终入选61例符合条件的病例,其中男性52例,女性9例,年龄26~70岁。三组患者术后(T2、T3时间点)OI均较术前(T1)明显降低,B、C组于T4恢复接近术前(T1)水平。术后(T2、T3)RI较术前(T1)升高,B、C组RI于T4恢复至接近术前(T1)水平,A组RI较术前明显升高,但组间变化趋势差异无统计学意义。与A组相比,B组术中输RBC例数及洗涤红细胞量明显减少;B、C两组术中输注血浆量、输血浆例数及出血量显著减少。B、C两组较A组术后RBC及血浆输注例数明显减少,血小板输注量及例数差异无统计学意义。术后24 h引流量B、C组均有减少趋势,但与A组比较差异无统计学意义。B、C两组术后带管时间及监护室停留时间较A组有降低趋势,差异无统计学意义。结论:B组(15~20 mL/kg)的自体血分离量在大血管手术中异体血输注量明显减少,术后48 h氧合指数、呼吸指数恢复更优,机械通气时间及ICU停留时间缩短。Objective:To analyze the effect of different volume of autologous platelet separation by Autologous plateletpheresis on lung function in patients undergoing acute aortic dissection surgery with moderate hypothermia circulatory arrest.Methods:Clinical data of patients who underwent acute type A aortic dissection surgery(Bentall+Sun’s surgery)with MHCA recently were retrospectively in this study.After all these cases were selected according to the selection/exclusion criteria,divided them into three groups by the volume of au-tologous blood collection with group A(>15 mL/kg),group B(15-20 mL/kg)and group C(<20 mL/kg).Oxygenation index(OI),respiratory index(RI)and alveolar-arterial oxygen partial pressure difference were cal-culated by the arterial blood gas analysis which were collected before operation(T1),1 h after operation(T2),24 h after operation(T3)and 48 h after operation(T4)respectively.Compare and analyze the differences in these lung function-related indicators,intraoperative blood loss,the volume of chest tube drainage at 24 h after surgery and perioperative allogeneic blood transfusion of three groups in each time point.Clinical characteristics including operative time,cardiopulmonary bypass time,cross-clamp time,deep hypothermia circulatory arrest time,the duration of mechanical ventilation after surgery,and the lengths of intensive care unit and hospital stays were recorded and compared among the three groups.Results:61 eligible cases were selected finally,in-cluding 52 males and 9 females,aged 26-70 years old.The postoperative(T2,T3)OI of three groups was sig-nificantly lower than that of the preoperative(T1),and group B and C recovered to the preoperative(T1)level at T4.Postoperative RI(T2,T3)were higher than preoperative(T1),RI of group B and C recovered to near preoperative(T1)level at T4,while RI of A group was significantly higher than preoperative RI,but there was no significant differences among the groups.Compared with group A,the number of cases of intraoperative RBC transfusion and the vo

关 键 词：自体血小板分离技术 主动脉手术 中低温停循环 肺功能 

分 类 号：R54[医药卫生—心血管疾病]