自体血小板分离与急性等容性血液稀释对体外循环下心脏手术血液保护效果的对比研究  

Comparative study of autologous plateletpheresis and acute normovolemic hemodilution technique on blood protection in cardiac surgery under cardiopulmonary bypass

作　　者：蔡成惠 赵芳 裴馨[1] 何琛[1] 车昊[1] 赵丽云[1] CAI Chenghui;ZHAO Fang;PEI Xin;HE Chen;CHE Hao;ZHAO Liyun(Department of Anesthesiology,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中心,100029

出　　处：《心肺血管病杂志》2022年第1期65-70,共6页Journal of Cardiovascular and Pulmonary Diseases

摘　　要：目的:对比自体血小板分离技术(APP)与急性等容性血液稀释(ANH)技术对体外循环下心脏外科手术患者的血液保护作用。方法:选取择期预计体外循环时间<2h的心脏手术患者90例,随机分为两组,每组45例。APP组在麻醉诱导后采集自体血进行血液分离,分离后的红细胞和贫血小板血浆按需回输,富血小板血浆于体外循环结束、鱼精蛋白中和肝素及外科无活动性出血时输注。ANH组于麻醉诱导后采集自体血并行急性等容性血液稀释,自体血于体外循环结束后回输。于麻醉诱导后(T1)、鱼精蛋白中和肝素后5min(T2)、自体血回输后(T3)三个时间点进行血气分析及血栓弹力图检测,并于术前(T0)、术后1d(T4)两个时间点进行凝血指标检测。主要观察指标为两组术后2h胸腔引流量及总胸腔引流量、异体血液制品输注量,同时对比两组凝血相关指标、止血药物使用情况、ICU停留时间、呼吸机使用时间、总住院天数、总住院费用等临床指标。结果:APP组术后总胸腔引流量大于ANH组,差异有统计学意义[(1176±399) vs.(1539±619)mL,P=0.003],围术期红细胞的输注率APP组大于ANH组,差异有统计学意义(5.1%vs 20.9%,P=0.036)。两组术后2h胸腔引流量、新鲜冰冻血浆输注率、止血药物的使用等临床指标,均差异无统计学意义。ANH组的R值在T3时间点较APP组低[4.8(4.2,5.6)vs. 6.3(4.8,7.8), P<0.001]。T4时间点,APP组APTT值延长较ANH组更为显著,差异有统计学意义[(28.7±2.5) vs.(33.0±5.5),P<0.001],其余各项指标两组间,均差异无统计学意义。结论:对于体外循环时间相对较短的心脏手术,APP技术未显示其优越性,ANH较APP技术具有更好的血液保护作用,确切的临床效果需进一步加大样本量进行研究来证实。Objective: To compare the blood protective effects of autologous plateletpheresis(APP) and acute normovolemic hemodilution(ANH) on cardiac surgery patients with short cardiopulmonary bypass time.Methods: Ninety patients were selected and randomly divided into two groups, 45 patients in each group. 8 patients were excluded for various reasons, finally 82 patients were enrolled into the APP group(n=43) and ANH group(n= 39). Autologous blood was collected for blood separation in the APP group after anesthesia induction, and the separated red blood cells and platelet poor plasma could be returned for transfusion as needed. Platelet-rich plasma is returned after cardiopulmonary bypass, protamine neutralization of heparin,and no surgical active bleeding. In ANH group, autologous blood was collected after anesthesia induction,and autologous blood was returned after cardiopulmonary bypass. Blood gas analysis and thrombelastogram were performed at three time points: after anesthesia induction(T1), 5 min after protamine neutralization(T2),and autologous blood transfusion(T3). Coagulation indexes were detected at two time points: before surgery(T0) and 1 day after surgery(T4). The main outcome indicators were thoracic drainage volume, total thoracic drainage volume and allogenic blood product infusion volume 2 h after surgery in the two groups. Meanwhile,the use of hemostatic drugs, ICU stay time, ventilator use time, total hospital stay, total hospitalization cost and other clinical indicators were compared between the two groups.Results: The total thoracic drainage volume in the APP group was greater than that in the ANH group, which was statistically different [(1 176±399)vs.(1 539±619)mL,P=0.003]. The perioperative red blood cell infusion rate in the APP group was greater than that in the ANH group. It is statistically significant(5.1% vs. 20.9%,P=0.036). There was no significant difference in clinical indicators such as chest drainage, fresh frozen plasma infusion rate, use of hemostatic drugs,etc. The R value of the

关 键 词：自体血小板分离 急性等容性血液稀释 体外循环 心脏外科手术 

分 类 号：R54[医药卫生—心血管疾病]