摘要
目的观察自体富血小板血浆(autologous platelet-rich plasma,aPRP)对深低温停循环(deep hypothermic circulatory arrest,DHCA)下的Stanford A型主动脉夹层手术中输血量和术后短期转归的影响。方法选择2016年6月至2017年8月在本院接受手术治疗的急性Stanford A型主动脉夹层患者83例,男60例,女23例,年龄24～81岁,BMI 19.0～41.9kg/m2,ASAⅣ级。根据是否制备aPRP将患者分为观察组(n=35)和对照组(n=48)。两组患者于麻醉诱导插管后经右侧颈内静脉置入三腔中心静脉导管和Swan-Ganz导管外鞘。随后,观察组于手术开始前完成aPRP制备,对照组开始手术。记录麻醉、手术、心肺转流(cardiopulmonary bypass,CPB)、主动脉阻断和DCHA时间。记录血栓弹力图反应时间(R)、α角和最大振幅(MA);记录术中出血量和红细胞、血浆、冷沉淀和血小板用量;记录术后机械通气时间、ICU留观时间、30d内严重并发症(神经系统并发症、需要持续肾脏替代治疗的急性肾功能不全、二次插管或气管切开、胸骨后感染或胸骨愈合不良、开胸止血)发生率和死亡率。结果观察组手术时间明显短于对照组(P<0.05)。麻醉、CPB、主动脉阻断时间差异无统计学意义。观察组DCHA时间明显短于对照组(P<0.05)。观察组TEGα角和MA明显大于对照组(P<0.05)。观察组术中红细胞、血浆和冷沉淀用量明显少于对照组(P<0.05)。两组术后机械通气时间、ICU留观时间、术后30d严重并发症发生率和死亡率差异无统计学意义。结论在DCHA下的Stanford A型主动脉夹层手术,aPRP可减少术中红细胞、血浆和冷沉淀的用量,但对术后机械通气时间、ICU时间、术后30d内严重并发症发生率和死亡率无明显影响。
Objective To observe the effect of autologous platelet rich plasma（aPRP）on intraoperative transfusions and short term outcomes postoperative in surgery for acute Stanford type A aortic dissection under deep hypothermic circulatory arrest.Methods Eighty three patients diagnosed as acute Stanford type A dissection scheduled for surgery from June 2016 to August 2017 in our hospital,60 males and 23 females,aged 24-81 years,BMI 19.0-41.9 kg/m2,ASA physical statusⅣ,were enrolled in this study.The participants were divided into observation group（n = 35）and control group（n = 48）according to harvesting aPRP or not.For all patients,a three-lumen central venous catheter and a Swan-Ganz catheter sheath were placed into right internal jugular vein after anesthetic induction and intubation.After this,aPRP was prepared preoperatively on patients in observation group,while procedure was performed on patients in control group.Durations of anesthesia,procedure,cardiopulmonary bypass（CPB）,aorta cross-clamping and deep hypothermic circulatory arrest were recorded.Parameters of thromboelastography as responding time（R）,αangle and maximal amplitude（MA）were recorded.Intraoperative blood loss and transfusions of erythrocyte,plasma,cryoprecipitate and platelet were recorded and compared.Duration of mechanical ventilation,length of ICU stay,incidence of severe complications（neurological complications,acute renal failure requiring continuous renal replacement therapy（CRRT）,reintubation or tracheotomy,posterior sternal infection or sternal opening,re-sternotomy for bleeding）and death in 30 days after surgery were recorded and compared.Results Duration of surgery in observation group was shorter compared to control group（P〈0.05）.Durations of anesthesia,CPB,aorta cross-clamping had no difference between two groups.The duration of deep hypothermic circulatory arrest was shorter in observation group（P〈0.05）.αAngle and MA value of thromboelastography were larger in observation group.Intraoperative transfusions of erythrocyte,plasma and cryoprecipitate were significantly reduced in observation group.No significant difference in duration of mechanical ventilation,length of ICU stay,severe complications and death in 30 days after surgery were found.Conclusion aPRP can reduce transfusions of erythrocyte,plasma and cryoprecipitate in surgery for acute Stanford type A dissection under deep hypothermic circulatory arrest,while this technique has no significant effect on short term outcomes postoperative.
作者
田文智
耳建旭
韩建阁
陈庆良
TIAN Wenzhi;ER Jianxu;HAN Jiange;CHEN Qingliang(Depart-ment of Anesthesiology,Tianjin Chest Hospital,Tianjin 300051,China)
出处
《临床麻醉学杂志》
CAS
CSCD
北大核心
2018年第10期974-978,共5页
Journal of Clinical Anesthesiology
关键词
自体富血小板血浆
深低温停循环
A型主动脉夹层
输血
转归
Autologous platelet rich plasma
Deep hypothermic circulatory arrest
Stanfordtype A dissection} Transfusion
Outcomes
作者简介
通信作者：韩建阁，Email：hanjiange@163．com
