|本期目录/Table of Contents|

[1]王永旺,喻文立,王清平,等.急性血小板分离或自体血回输对体外循环冠状动脉旁路移植术患者血液保护的影响[J].天津医科大学学报,2016,22(06):494-497.
　WANG Yong-wang,YU Wen-li,WANG Qing-ping,et al.Blood-saving effects of acute plateletpheresis and autologous blood transfusion in patients undergoing coronary artery bypass grafting by CPB[J].Journal of Tianjin Medical University,2016,22(06):494-497.
点击复制

急性血小板分离或自体血回输对体外循环冠状动脉旁路移植术患者血液保护的影响(PDF)
分享到：

《天津医科大学学报》[ISSN:1006-8147/CN:12-1259/R]

卷:
22卷
期数:
2016年06期
页码:
494-497
栏目:
临床医学
出版日期:
2016-11-20

文章信息/Info

Title:
Blood-saving effects of acute plateletpheresis and autologous blood transfusion in patients undergoing coronary artery bypass grafting by CPB
文章编号:
1006-8147（2016）06-0494-4
作者:
王永旺1; 喻文立1; 王清平1; 翁亦齐1; 杜洪印1; 王 刚1; 于泳浩2
（1.天津医科大学一中心临床学院麻醉科，天津 300192；2.天津医科大学总医院麻醉科，天津 300052）
Author(s):

WANG Yong-wang1; YU Wen-li1; WANG Qing-ping1; WENG Yi-qi1; DU Hong-yin1;  WANG Gang1; YU Yong-hao2

?

(1.Deparment of Anesthesiology，The First Center Clinical College，Tianjin Medical University，Tianjin 300192, China；2.Department of Anesthesiology，General Hospital，Tianjin Medical University，Tianjin 300052，China)
关键词:
血小板; 输血; 自体; 心肺转流术; 冠状动脉旁路移植术; Sonoclot血小板功能分析仪
Keywords:
blood platelets; blood transfusions;  autologous; cardiopulmonary bypass; coronary artery bypass grafting; sonoclot coagulation and platelet function analyzer
分类号:
R614
DOI:
-
文献标志码:
A
摘要:
?目的：比较急性血小板（Plt）分离与自体血回输对体外循环（CPB）冠状动脉旁路移植术（CABG）患者的血液保护效果。 方法：择期拟在CPB下CABG 患者60例，ASA分级Ⅱ级或Ⅲ级，年龄40～65岁，体质量70～103 kg。采用随机数字表法，将患者随机分为3组（n=20）：对照组（C组）、自体血回输组（Z组）和急性Plt分离组(APP组)。APP组在麻醉诱导后行APP，提取富Plt血浆，于CPB结束鱼精蛋白中和肝素后10 min回输，Z组在麻醉诱导后行自体血放血入枸橼酸保存液血袋，回输同APP组，C组不作处理。于麻醉诱导后5 min（T1）、鱼精蛋白中和肝素后10 min（T2）和术后即刻（T3），采集中心静脉血样，检测血常规和Sonoclot凝血及血小板功能，记录Hb、Plt、凝血速率（CR）及血小板功能（PF）。记录CPB时间、主动脉阻断时间、关胸时间、术后引流量和输血情况。结果：与C组比较，Z组和APP组T3时Plt、CR升高，APP组T3时PF升高，Z组和APP组术后24 h引流量减少，异体血浆输注量和红细胞输注量减少，异体红细胞输注率和异体血浆输注率降低（P<0.05或<0.01）。与Z组比较，APP组T3时PF升高（P<0.05）。 结论：急性Plt分离或自体血回输对体外循环冠状动脉旁路移植术患者具有相似的血液保护作用, 但是前者可以增强血小板功能。
Abstract:
Objective ：To compare the blood-saving effects of acute plateletpheresis (APP) and autologous blood during back-transfusion in patients undergoing coronary artery bypass grafting (CABG) by CPB. Methods：Sixty ASA Ⅱ or Ⅲ patients aged 40-65 years, weighing 70-103 kg , scheduled for CABG with CPB were randomly divided into 3 groups (n=20 each):control group(group C),atologous blood group(group Z) and APP group. In APP group and group Z, platelet-rich plasma and autologous blood were collected immediately after induction of anesthesia and transfused back to the patient 10 min after neutralization of heparin with protamine. Hb, Plt, clot rate(CR) and platelet function (PF) were measured 5 min after induction(T1), 10 min after neutralization of heparin (T2) and immediately after operation. CPB time (T3), aortic crossclamping time , closing chest time , postoperative chest tube drainage and blood product requirements were recorded. Results：The platelet count and CR at T3 were higher in other two groups than in group C, PF at T3 was higher in APP group than in group C. The volume of postoperative chest tube at 24h after operation, allogeneic plasma and RBC volume，the incidence of allogeneic RBC and plasma were lower in other two groups than in group C. PF at T3 was higher in APP group than in group Z (P<0.05 or P <0.01). Conclusion：APP and atologous blood may have similar blood-saving effect in patients undergoing CABG with CPB，but APP may increase the platelet function.

参考文献/References:

[1]Johnson D J, Scott A V, Barodka V M, et al. Morbidity and mortality after high-dose transfusion[J]. Anesthesiology,2016,124(2):387
[2]Yap C H, Lau L, Krishnaswamy M, et al. Age of transfused red cells and early outcomes after cardiac surgery[J]. Ann Thorac Surg, 2008,86 (2):554
[3]Likosky D S, Zhang M, Paone G, et al. Impact of institutional culture on rates of transfusions during cardiovascular procedures:the Michigan experience[J]. Am Heart J,2016,174:1
[4] Alberts M, Bandarenko N, Gaca J, et al. Reduced use of allogeneic platelets through high-yield perioperative autologous plateletpheresis and reinfusion[J]. Transfusion,2014, 54 (5):1348
[5]Klein A A, Nashef S A, Sharples L A, et al. A randomized controlled trial of cell salvage in routine cardiac surgery[J]. Anesth Analg,2008,107(5):1487
[6] Vermeijden W J, Hagenaars J A, Scheeren T W, et al. Additional
postoperative cell salvage of shed mediastinal?blood?in cardiac
surgery does not reduce allogeneicblood?transfusions:a cohort
study[J]. Perfusion,2015 [Epub ahead of print]
[7]严海雅.自体输血操作规程与质量控制[M].杭州:浙江大学出版社,2010:1-
[8]魏海燕，史宏伟，鲍红光，等.急性血小板分离回输对体外循环心脏直视手术患者的血液保护效果[J].中华麻醉学杂志,2011,31(7):812[9]Hartoq C S, Reuter D, Loesche W, et al. Influence of hydroxyethl starch(HES)130/0.4 on hemostasis as measured by viscoelastic device analysis:a systematic review[J]. Intensive Care Med,2011,37(11):1725
[10] Wan P, Yu M, Qian M. Sonoclot coagulation analysis:a useful tool to predict mortality in overt disseminated intravascular coagulation[J]. Blood Coagul Fibrinolysis,2016,27(1):77
[11]Stogermuller B, Stark J, Willschke H, et al. The effect of hydroxyethyl starch 200kD on platelet function[J]. Anesth Analg, 2000, 91(4):823
[12]Harrison P. Platelet function analysis[J]. Blood Rev,2005,19 (2):111
[13]Kurak J, Zajac P, Czyzewski D, et al. Evaluation of platelet function using PFA-100?in patients treated with Acetylsalicylic acid and qualified for Trauma and Orthopedic surgery procedures[J]. Platelets, 2016,20:1

相似文献/References:

[1]余信,蒋佳维,许华,等.血小板联合D-二聚体对脓毒症预后的评估价值[J].天津医科大学学报,2020,26(02):145.
　YU Xin,JIANG Jia-wei,XU Hua,et al.Prognostic value of platelet combined with D-dimer in sepsis[J].Journal of Tianjin Medical University,2020,26(06):145.
[2]郝增光,韩兆帅,葛慧敏.血小板与淋巴细胞比值评估合并多支血管病变的急性心肌梗死患者预后的价值[J].天津医科大学学报,2021,27(02):150.
　HAO Zeng-guang,HAN Zhao-shuai,GE Hui-min.The value of platelet to lymphocyte ratio in evaluating the prognosis of patients with acute myocardial infarction combined with multivessel disease[J].Journal of Tianjin Medical University,2021,27(06):150.

备注/Memo

备注/Memo:

基金项目 天津市卫计委科技基金资助项目（2015kz027）

作者简介 王永旺（1981），男，主治医师，博士在读，研究方向：心血管、器官移植麻醉；通信作者：于泳浩，E-mail： yuyonghao@126.com。



?

更新日期/Last Update: 2016-11-25