自体血小板分离技术在A型主动脉夹层手术患者的应用
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摘要
目的观察自体血小板分离技术在A型主动脉夹层手术患者的应用效果。方法行A型主动脉夹层手术患者68例,随机分为两组:试验组32例,术中应用自体血小板分离制备富血小板血浆,给予鱼精蛋白中和肝素后回输给患者;对照组36例,进行常规血液回收,未行自体血小板分离。在麻醉诱导后肝素化之前(T1)、鱼精蛋白中和肝素且富血小板血浆回输后5 min(T2)、术后1 h(T3)、术后24 h(T4)检测患者血小板计数。比较两组术中及术后情况。结果在T2、T3、T4时,试验组血小板计数高于对照组(P<0.05)。两组患者手术时间、体外循环时间、主动脉阻断时间、深低温停循环时间、血小板输入量、机械通气时间、ICU停留时间比较无统计学差异(P>0.05),试验组患者红细胞输入量、血浆输入量以及冷沉淀输入量少于对照组(P<0.05)。两组并发症发生情况及死亡情况比较无统计学差异(P>0.05)。结论 A型主动脉夹层手术中应用自体血小板分离可以有效减少输血量。
Objective To observe the application efficiency of autologous platelet separation technique in the patients undergoing surgery for type A aortic dissection.Methods A total of 68 cases underwent type A aortic dissection operation was randomly divided into two groups.The platelet-rich plasma was prepared by autologous platelet separation during operation in group A(32 cases),which was given back to the patients after protamine neutralizing heparin.The routine blood collection was performed without autologous platelet separation in group C(36 cases).The platelet count was detected before heparinization and after induction of anesthesia(T1),protamine neutralizing heparin and 5 minutes after platelet-rich plasma reinfusion(T2),one hour(T3) and 24 hours(T4) after operation.The operation-related indicators were compared between two groups.Results The platelet count at T2,T3 and T4 was higher in group A than that in group C(P<0.05).The time of operation,extracorporeal circulation,aortic cross clamping and deep hypothermic circulatory arrest,platelet input,mechanical ventilation time and ICU stay were all not significantly different between two groups(P>0.05).The transfusions of red blood cells,plasma and cryoprecipitation were lower in group A than those in group C(P<0.05).The complications and death were not significantly different between two groups(P>0.05).Conclusion The use of autologous platelet separation can effectively reduce the amount of blood transfusion in the patients undergoing surgery for type A aortic dissection.
Objective To observe the application efficiency of autologous platelet separation technique in the patients undergoing surgery for type A aortic dissection.Methods A total of 68 cases underwent type A aortic dissection operation was randomly divided into two groups.The platelet-rich plasma was prepared by autologous platelet separation during operation in group A(32 cases),which was given back to the patients after protamine neutralizing heparin.The routine blood collection was performed without autologous platelet separation in group C(36 cases).The platelet count was detected before heparinization and after induction of anesthesia(T1),protamine neutralizing heparin and 5 minutes after platelet-rich plasma reinfusion(T2),one hour(T3) and 24 hours(T4) after operation.The operation-related indicators were compared between two groups.Results The platelet count at T2,T3 and T4 was higher in group A than that in group C(P<0.05).The time of operation,extracorporeal circulation,aortic cross clamping and deep hypothermic circulatory arrest,platelet input,mechanical ventilation time and ICU stay were all not significantly different between two groups(P>0.05).The transfusions of red blood cells,plasma and cryoprecipitation were lower in group A than those in group C(P<0.05).The complications and death were not significantly different between two groups(P>0.05).Conclusion The use of autologous platelet separation can effectively reduce the amount of blood transfusion in the patients undergoing surgery for type A aortic dissection.
引文
[1] 邓丽,刘宗弘,杨慧,等.自体富含血小板血浆分离技术在主动脉外科中的应用[J].中国心血管病研究,2015,13(10):925-929.
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[5] 袁辉,黄维勤,罗纲,等.自体血小板分离回输在Stanford A型主动脉夹层手术中血液保护作用的随机对照试验[J].中国胸心血管外科临床杂志,2017,24(2):104-109.
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[8] Zhou SF,Estrera AL,Loubser P,et al.Autologous platelet-rich plasma reduces transfusions during ascending aortic arch repair:a prospective,randomized,controlled trial[J].Ann Thorac Surg,2015,99(4):1282-1290.
[9] 袁辉,黄维勤,袁世荧.自体血小板分离在大血管手术中的血液保护作用[J].中国心血管病研究,2016,14(11):1030-1034.
[10] 罗智超,彭东,周成斌,等.自体血小板分离技术在全弓置换术中的初步应用[J].中国体外循环杂志,2016,14(3):145-147,171.
[11] 汪雍媛,纪宏文.自体血小板分离对深低温停循环主动脉手术的血液保护作用[J].中国输血杂志,2016,29(4):441-444.
[12] Jee CH,Eom NY,Jang HM,et al.Effect of autologous platelet-rich plasma application on cutaneous wound healing in dogs[J].J Vet Sci,2016,17(1):79-87.
[13] Cohn CS,Lockhart E,Mccullough JJ.The use of autologous platelet-rich plasma in the orthopedic setting[J].Transfusion,2015,55(7):1812-1820.
[14] 魏海燕,丁正年,史宏伟,等.急性血小板分离回输对体外循环下心内直视手术患者血小板活化功能的影响[J].中华麻醉学杂志,2015,35(3):274-278.
[15] Zhou SF,Estrera AL,Miller CC 3rd,et al.Analysis of autologous platelet-rich plasma during ascending and transverse aortic arch surgery[J].Ann Thorac Surg,2013,95(5):1525-1530.
[2] 柴云飞,张建军,雷黎明,等.主动脉全弓置换术中自体血小板分离采集的麻醉管理[J].川北医学院学报,2017,32(3):348-351.
[3] O’Neill EM,Zalewski WM,Eaton LJ,et al.Autologous platelet-rich plasma isolated using the Haemonetics Cell Saver 5 and Haemonetics MCS+ for the preparation of platelet gel[J].Vox Sanguinis,2015,81(3):172-175.
[4] 吕有凯,王曰兴,葛广全,等.不同血液净化方式治疗心脏术后急性肾损伤对比观察[J].中国急救医学,2017,37(2):173-176.
[5] 袁辉,黄维勤,罗纲,等.自体血小板分离回输在Stanford A型主动脉夹层手术中血液保护作用的随机对照试验[J].中国胸心血管外科临床杂志,2017,24(2):104-109.
[6] 臧旺福,李沅敏,周健,等.血小板分离回输对心脏外科手术患者血小板和凝血功能的影响[J].国际心血管病杂志,2017,44(1):46-49.
[7] Xu FT,Li HM,Yin QS,et al.Effect of activated autologous platelet-rich plasma on proliferation and osteogenic differentiation of human adipose-derived stem cells in vitro[J].Am J Transl Res,2015,7(2):257-270.
[8] Zhou SF,Estrera AL,Loubser P,et al.Autologous platelet-rich plasma reduces transfusions during ascending aortic arch repair:a prospective,randomized,controlled trial[J].Ann Thorac Surg,2015,99(4):1282-1290.
[9] 袁辉,黄维勤,袁世荧.自体血小板分离在大血管手术中的血液保护作用[J].中国心血管病研究,2016,14(11):1030-1034.
[10] 罗智超,彭东,周成斌,等.自体血小板分离技术在全弓置换术中的初步应用[J].中国体外循环杂志,2016,14(3):145-147,171.
[11] 汪雍媛,纪宏文.自体血小板分离对深低温停循环主动脉手术的血液保护作用[J].中国输血杂志,2016,29(4):441-444.
[12] Jee CH,Eom NY,Jang HM,et al.Effect of autologous platelet-rich plasma application on cutaneous wound healing in dogs[J].J Vet Sci,2016,17(1):79-87.
[13] Cohn CS,Lockhart E,Mccullough JJ.The use of autologous platelet-rich plasma in the orthopedic setting[J].Transfusion,2015,55(7):1812-1820.
[14] 魏海燕,丁正年,史宏伟,等.急性血小板分离回输对体外循环下心内直视手术患者血小板活化功能的影响[J].中华麻醉学杂志,2015,35(3):274-278.
[15] Zhou SF,Estrera AL,Miller CC 3rd,et al.Analysis of autologous platelet-rich plasma during ascending and transverse aortic arch surgery[J].Ann Thorac Surg,2013,95(5):1525-1530.