自体富血小板血浆分离-回输术用于胸腰椎板切除术患者血液保护的价值  

Value of autologous platelet-rich plasma separation-retransfusion for blood conservation in patients undergoing thoracolumbar laminectomy

作　　者：杨亚利 姚翔燕 李慧蕴 李陈茜 李宁 孟星 张加强 Yang Yali;Yao Xiangyan;Li Huiyun;Li Chenxi;Li Ning;Meng Xing;Zhang Jiaqiang(Department of Anesthesiology and Perioperative Medicine,Henan Provincial People′s Hospital,People′s Hospital of Zhengzhou University,Zhengzhou 450003,China)

机构地区：[1]河南省人民医院麻醉与围术期医学科、郑州大学人民医院,郑州450003

出　　处：《中华麻醉学杂志》2023年第12期1478-1481,共4页Chinese Journal of Anesthesiology

摘　　要：目的评价自体富血小板血浆(aPRP)分离-回输术用于胸腰椎板切除术患者血液保护的价值。方法择期胸腰三节段椎板切除术患者60例,性别不限,年龄18~60岁,ASA分级Ⅰ或Ⅱ级,BMI 19~30 kg/m^(2)。采用随机数字表法分成2组(n=30):常规血液保护组(C组)和aPRP血液保护组(aPRP组)。C组采用氨甲环酸+自体血回收-回输术;aPRP组采用aPRP分离-回输术+氨甲环酸+自体血回收-回输术。记录异体血输注量、异体血免除情况和不良反应发生情况。于术前1 d(T_(0))、出血500 ml(T_(1))、术毕(T_(2))、术后24和48 h(T_(3,4))时采集静脉血样,采用ELISA法检测血浆IL-6和IL-10浓度;记录低氧血症发生情况和术后24 h切口引流量。结果与C组比较,aPRP组异体红细胞及血浆的输注量和术后24 h切口引流量明显降低(P<0.05),异体红细胞及血浆的免除率明显升高(30%vs 47%、10%vs 60%,P<0.05);T_(2-4)时血浆IL-6和IL-10浓度降低(P<0.05),PACU低氧血症发生率降低(27%vs 10%,P<0.05)。结论aPRP分离-回输术对胸腰三节段椎板切除术患者常规血液保护,具有明显的改良效果。Objective To evaluate the value of autologous platelet-rich plasma(aPRP)separation-retransfusion for blood conservation in the patients undergoing thoracolumbar laminectomy.Methods Sixty American Society of Anesthesiologists Physical Status classificationⅠorⅡpatients,aged 18-60 yr,with body mass index of 19-30 kg/m^(2),scheduled for elective thoracolumbar laminectomy,were divided into 2 groups(n=30 each)using a random number table method:conventional blood conservation group(group C)and aPRP blood conservation group(group aPRP).Group C received tranexamic acid and autologous blood salvage-retransfusion.Group aPRP received aPRP separation-retransfusion,tranexamic acid and autologous blood salvage-retransfusion.The volume of allogeneic blood transfused,percentage of patients who did not need the allogeneic blood transfusion and adverse reactions were recorded.Venous blood samples were collected for blood routine examination and for determination of the plasma concentrations of interleukin-6(IL-6)and IL-10 at 1 day before operation(T_(0)),when the volume of blood loss reached 500 ml(T_(1)),immediately after surgery(T_(2)),and at 24 and 48 h after surgery(T_(3,4)).The incidence of hypoxemia and amount of 24-h wound drainage were recorded.Results Compared with group C,the amount of allogeneic red blood cells,plasma transfused and 24-h wound drainage were significantly decreased(P<0.05),the percentage of patients who did not need the allogeneic red blood cell and plasma transfusion was increased(30%vs 47%,10%vs 60%,P<0.05),the plasma concentrations of IL-6 and IL-10 at T_(2-4) were significantly decreased(P<0.05),and the incidence of hypoxemia in PACU was decreased in group aPRP(27%vs 10%,P<0.05).Conclusionsa PRP separation-retransfusion can provide marked improvement in conventional blood conservation in the patients undergoing thoracolumbar laminectomy.

关 键 词：输血 自体 富血小板血浆 椎板切除术 腰椎 胸椎 

分 类 号：R687.3[医药卫生—骨科学]