摘要
目的比较富血小板血浆(PRP)分离与急性等容性血液稀释(ANH)对体外循环(ECC)冠状动脉旁路移植术(CABG)患者的血液保护效果。方法选取CABG术患者60例,随机分为ANH组(A组)和PRP分离(P组)。A组在麻醉诱导后经颈内静脉放血,放出的血液待ECC结束后回输入患者体内。P组在麻醉诱导后使用血细胞回收机经颈内静脉采集自体全血行PRPS,分离出的贫血小板血浆(PPP)和红细胞即刻回输入患者体内,PRP待ECC结束后回输入患者体内。于麻醉诱导后即刻(T0)、ECC开始前即刻(T1)、ECC开始后5 min(T2)、患者出手术室时(T3)和术后24h(T4)五个时间点抽取血标本,测定红细胞比容(Hct)和血小板计数(Plt),使用全血凝血和血小板功能分析仪测定T1和T4两个时间点的凝血速率(CR)和血小板功能(PF)。纪录两组的ECC时间、主动脉阻断时间、围术期4%琥珀酰明胶用量、术后24 h内胸腔引量和血制品使用量。结果 Hct值:两组各时相与T0时相比,T1、T2和T3均降低(P<0.05或P<0.01),但P组T1下降不明显(P>0.05),T4时相均升高至T0水平(P>0.05)。两组间比较,P组T1和T2时均高于A组(P<0.05或P<0.01)。Plt值:两组各时相与T0比较均降低(P<0.05或P<0.01)。两组间比较,T0和T4时无差异(P>0.05),T1和T2时P组低于A组(P<0.05),T3时P组显著高于A组(P<0.01)。CR和PF:A组T3时较T0时显著降低(P<0.01);P组T3时则恢复至T0水平(P>0.05)。P组术后24 h胸引量和红细胞输入量显著少于A组。结论 PRPS术后回输和ANH对ECC下CABG术患者具有相似的血液保护效果,但是前者可以在不减少围术期血红蛋白水平的基础上极大程度地对血小板数量和功能进行维持,因而具有更为有效的血液保护作用。
Objective To compare blood preservation effects of platelet-rich plasma sequestration(PRPS) and acute normovolemic hemodilution(ANH) in patients undergoing coronary artery bypass grafting(CABG) with extracorporeal circulation(ECC).Methods 60 consecutive patients who were to undergo an elective CABG with ECC were randomly divided into ANH(A) group and PRPS(P) group.In A group,blood removal was performed via right internal jugular after induction of anesthesia.The blood was reinfused to the patient after ECC.In P group,blood was removed via right internal jugular after induction of anesthesia and was separated into platelet-poor plasma(PPP),PRP and blood cell by a cell saver(electa,Sorin Group,Italy).PPP and blood cell were rein-fused back to the patient immediately.PRP was reinfused after ECC.Hb and Plt were measured after induction(T0),before ECC(T1),5 min after ECC onset(T2),after operation(T3) and 24 hours after operation(T4).Clot rate(CR) and platelet function(PF) were analyzed at T1 and T4 with Sonoclot analyzer(Sienco.Inc,USA).ECC time,aortic cross-clamping time,volume of 4% gelatin,postoperative chest tube drainage and blood product requirements were recorded.Results In A group,Hct significantly decreased at T1,T2,and T3 than T0(P<0.05 or P<0.01) and increased to the same value with T0 at T4(P>0.05).Plt decreased at T1,T2,T3 and T4(P<0.05 or P<0.01).In P group,compare with T0,Hct did not decrease at T1(P>0.05),but was lower at T2 and T3(P<0.05 or P<0.01),and it increased to the same value with T0 at T4(P>0.05).Plt was lower at T1,T2,T3 and T4(P<0.05 or P<0.01).Comparing Hct between P group and A group,there was no difference at T0,T3 and T4(P>0.05),but higher at T1 and T2(P<0.05 or P<0.01) in P group.There was no differences between two groups on Plt at T0 and T4(P>0.05).Plt were lower at T1 and T2 in P group than in A group(P<0.05),and much higher at T3 in P group than in A group.In A group,CR and PF decreased significantly at T3 than at T0(P<0.01).In P group,CR and PF at T3 were same at T0(P>0.05).The 24-hour mediastinal drainage volume was lower significantly in P group than in A group,so was allogeneic red blood cell requirement.Conclusion PRPS and ANH have similar blood preservation effects in patients undergoing CABG with ECC.Whereas PRPS can preserve platelet function as much as possible without low Hb level.So PRPS has more effective blood preservation effect than ANH.
出处
《中国体外循环杂志》
2013年第4期213-216,共4页
Chinese Journal of Extracorporeal Circulation
基金
国家临床重点专科建设项目资助
关键词
富血小板血浆
急性等容性血液稀释
体外循环
冠状动脉旁路移植术
Platelet-rich plasma
Acute normovolemic hemodilution
Extracorporeal circulation
Coronary artery bypass grafting surgery
