不同MAPP量对心脏瓣膜置换手术患者肺功能保护及凝血功能的影响  

Effect of different levels of MAPP on lung function protection and coagulation function in patients undergoing heart valve replacement surgery

作　　者：刘芳 李彩霞[1] 韩新[2] 王发兴 LIU Fang;LI Caixia;HAN Xin;WANG Faxing(Department of Blood Transfusion,Lishui People's Hospital,Lishui,323000,China;Department of Anesthesiology,Lishui People's Hospital)

机构地区：[1]丽水市人民医院输血科,浙江丽水323000 [2]丽水市人民医院麻醉科

出　　处：《临床血液学杂志》2023年第12期878-883,共6页Journal of Clinical Hematology

基　　金：浙江省医药卫生科技计划项目(No:2023KY1378)。

摘　　要：目的:探讨不同改良自体血小板分离(MAPP)量对心脏瓣膜置换手术患者肺功能保护及凝血功能的影响。方法:纳入2019年1月—2023年1月医院住院成人心脏瓣膜病95例患者进行前瞻性随机对照试验。根据随机数字表分成3组:A组(MAPP<10 mL/kg)31例、B组(MAPP为10~15 mL/kg)32例、C组(MAPP>15 mL/kg)32例。比较3组凝血功能及术后72 h内急性肺损伤发生情况。结果:研究过程中剔除各组MAPP分离至目标量前红细胞比容持续<20%者,每组均有30例患者进入研究。与A组比较,B、C组在体外循环结束即刻(L3)时活化部分凝血酶原时间(APTT)明显延长,血浆纤维蛋白原(Fib)浓度升高(P<0.05),但B组和C组L3时APTT、Fib值比较,差异无统计学意义(P>0.05);B组和C组L3、术后1 h(L4)、24 h(L5)时最大血块强度(MA)值均高于A组(P<0.05),但B组和C组L3、L4、L5时MA值比较,差异无统计学意义(P>0.05)。A组术后72 h急性肺损伤发生率为6.67%,B组为3.33%,C组为10.00%。3组急性肺损伤发生率比较,差异无统计学意义(χ^(2)=1.012,P=0.868)。结论:10~15 mL/kg MAPP分离量对改善心脏瓣膜置换手术患者的凝血功能最佳,同时该分离量不会增加急性肺损伤发生率。Objective:To investigate the effects of different levels of modified autologous platelet-rich plasmapheresis(MAPP)on lung function protection and coagulation function in patients undergoing heart valve replacement surgery.Methods:A prospective randomized controlled trial was conducted on 95 adult patients with valvular heart disease admitted to our Hospital from January 2019 to January 2023.According to a random number table,they were randomly divided into three groups:Group A(MAPP<10 mL/kg)with 31 cases,Group B(MAPP 10-15 mL/kg)with 32 cases and Group C(MAPP>15 mL/kg)with 32 cases.The effect of different levels of MAPP on lung function protection and coagulation function in patients undergoing double valve replacement surgery was analyzed.Results:During the study,patients with hematocrit<20%before MAPP separation to the target volume were excluded,and 30 patients in each group were enrolled in the study.Compared with Group A,Group B and Group C significantly prolonged the activated partial prothrombin time(APTT)and increased plasma fibrinogen(FIB)concentration immediately after the end of cardiopulmonary bypass(L3)(P<0.05).However,there was no statistical significant difference in APTT and FIB values between Group B and Group C at L3(P>0.05).The maximum blood clot strength(MA)values at L3,1 hour(L4),and 24 hours(L5)after surgery in Group B and Group C were higher than those in Group A(P<0.05),but there was no statistical significant difference in MA values between Group B and Group C at L3,L4,and L5(P>0.05).The incidence of acute lung injury at 72 h after operation in group A,B,C was 3.33%,6.67%and 10.00%.There was no statistical significant difference in the incidence of acute lung injury among the three groups(χ^(2)=1.012,P=0.868).Conclusion:The separation amount of 10-15 mL/kg MAPP may be the best for improving coagulation function in the patients undergoing heart valve replacement surgery,and the separation amount would not increase the incidence of acute lung injury.

关 键 词：心脏瓣膜置换术 改良自体血小板分离 凝血功能 肺功能 

分 类 号：R457.1[医药卫生—治疗学]