主动脉全弓置换术中自体富血小板血浆分离技术的有效性研究  

Effectiveness of platelet-rich plasma separation technique in total aortic arch replacement

作　　者：庞超 张韶鹏 白云鹏[2] 谢淑华[1] PANG Chao;ZHANG Shaopeng;BAI Yunpeng;XIE Shuhua(Department of Anesthesiology,Tianiin Union Medical Center,The First Affiliated Hospital of Nankai University,Tianjin 300121;China Chest Hospital of Tianjin University,Tianjin Cardiovascular Disease Research Institute,Tianjin Key Laboratory of Cardiovascular Emergency and Critical Care,Tianjin 300222,China)

机构地区：[1]天津市人民医院,南开大学第一附属医院麻醉科,天津300121 [2]天津大学胸科医院,天津心血管病研究所,天津市心血管急危重症重点实验室,天津300222

出　　处：《中国输血杂志》2025年第2期189-193,共5页Chinese Journal of Blood Transfusion

基　　金：天津市医学重点学科(专科)建设项目(TJYXZDXK-042A);天津市应用基础研究重点项目(22JCYBJC01430);天津市科技计划项目(21JCZDJC00610)。

摘　　要：目的探讨主动脉夹层患者行全弓置换术中应用自体富血小板血浆(aPRP)的有效性与可行性。方法回顾性分析2016年1月—2023年11月行主动脉全弓置换术的A型主动脉夹层患者483例,根据是否接受输入aPRP分为2组:aPRP组(n=357)和非aPRP组(n=126),比较2组患者基线情况、术中用血情况及术后结局。结果aPRP组异体血小板(1.55±1.04 vs 1.60±1.27)U、异体血浆(480.89±432.49 vs 746.50±508.81)mL、异体红细胞(5.95±1.91 vs 6.17±3.52)U、巴曲亭(2.66±1.51 vs 3.31±1.59)U、凝血因子Ⅶ(0.67±1.03 vs 1.22±1.43)mg的用量均低于非aPRP组(P<0.05)。aPRP组术后低氧发生率(43.98%vs 48.41%),呼吸机使用时间[50.91(18.71,113.71)vs 83.40(37.73,151.98)h]均低于非aPRP组。2组患者在术后死亡、持续床旁血滤、脑梗死、脑出血、截瘫、二次开胸止血等方面均无差异(P>0.05)。结论主动脉全弓置换术中应用aPRP可有效减少术中用血和肺损伤相关并发症均发生,但在死亡、脑梗等其他并发症方面未见明显优势。Objective To evaluate the efficacy and practicality of autologous platelet-rich plasma(aPRP)in patients undergoing total aortic arch replacement for aortic dissection.Methods A retrospective analysis was performed on 483 patients diagnosed with type A aortic dissection who underwent total aortic arch replacement between January 2016 and November 2023.Patients were categorized into two groups based on whether they received aPRP.Baseline characteristics,intraoperative blood product usage and postoperative outcomes were compared between the two groups.Results The aPRP group exhibited reduced usage of allogeneic platelets(1.55±1.04 vs 1.60±1.27)U,allogeneic plasma(480.89±432.49 vs 746.50±508.81)mL,allogeneic RBC(red blood cell)(5.95±1.91 vs 6.17±3.52)U,bivalirudin(2.66±1.51 vs 3.31±1.59)U and coagulation factorⅦ(0.67±1.03 vs 1.22±1.43)mg compared to the non-aPRP group(P<0.05).The incidence of postoperative hypoxemia was lower in the aPRP group(43.98%vs 48.41%),and the duration of mechanical ventilation was significantly shorter[median 50.91(interquartile range 18.71,113.71)vs 83.40(37.73,151.98)hours].There were no significant differences between the two groups in terms of postoperative mortality,continuous bedside hemofiltration,cerebral infarction,cerebral hemorrhage,paraplegia or re-exploration for hemostasis(P>0.05).Conclusion The application of aPRP in total aortic arch replacement effectively diminishes intraoperative blood product usage and the incidence of lung injury-related complications.However,it does not demonstrate significant benefits in terms of mortality,cere-bral infarction and other complications.

关 键 词：主动脉夹层 输血 富血小板血浆 

分 类 号：R457.1[医药卫生—治疗学] R54[医药卫生—临床医学] R331.143