自体血小板分离在心脏大血管手术中的应用

发布时间：2018-02-03 23:08

本文关键词： 自体血小板分离心脏大血管手术深低温体外循环　出处：《青岛大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的探讨自体血小板分离技术在心外科大血管手术特别是深低温停循环手术中的临床价值,为自体血小板分离回输技术在心外科的应用提供一定的临床数据支持。方法我们回顾性的分析了在2015年1月到2017年2月期间,于青岛大学附属医院心血管外科行升主动脉及主动脉弓手术的患者126例。其中男性患者104人,女性22人。患者年龄在26-76岁,平均(53.72+10.99)岁。所有患者被分为两组。一组为自体血小板分离组,另一组为非自体血小板分离组。自体血小板分离组在术前常规行自体血小板分离程序,非自体血小板分离组则未行血小板的分离操作。采用自体血小板分离并回输的患者51例,非自体血小板分离回输的患者75例。APRP组术中采用自体血小板分离技术,分离患者自体血小板并震荡保存,于鱼精蛋白中和后回输患者,非APRP组仅采用血液回收技术。比较两组患者术前、术中及术后的相关指标并记录,最后应用统计学软件来进行数据分析。结果术前进行自体血小板分离的过程中,平均采集患者的全血量(1350±302)ml,分离耗时(32±12)min,平均分离得到的患者富血小板血浆量(192±43)ml,其中,富血小板血浆中含有的血小板浓度为(802±176)×109/L,分离出的富血小板血浆中血小板含量占全身血小板总数平均值为(23±3%)。总计7例患者被排除在外,其中,2例患者术前应用了华法林或阿司匹林、波立维等抗凝药物,3例患者心功能在III级以下,另有2例患者为急性的主动脉夹层,破口位于升主动脉及降主动脉,且破口影响了患者腹腔脏器的血运,出现了肾功能不全或心包积液的情况。最终有106名患者被纳入本研究(第一组35例,第一组71例),对所有106名患者的结果统计分析。患者的术前资料如表1所示,其中,72例患者患有高血压,其中第一组(21%)和第二组(51%)。6例病人被诊断为冠心病,第一组及第二组各3例。有6例马凡氏综合症的患者,第一组2例,第二组4例。分离组死亡2例,自动出院3例,死亡率4.6%,非分离组死亡13人,自动出院5人,死亡率20.6%。经排除后,分离组有43例患者被纳入研究,非分离组有63例患者被纳入研究。分析两组患者的术后统计资料发现,使用自体血小板分离回输技术并不会明显增加患者的术中的出血量及手术时长,但是可以明显降低患者术后早期的引流量、输血制品的费用等指标。结论自体血小板分离技术在不显著增加患者术中出血的前提下,可以明显降低心脏大血管手术患者术后早期引流量及围术期的血制品用量,并且,显著降低患者的院内死亡率。
[Abstract]:Objective to investigate the clinical value of autologous platelet separation in cardiac surgery, especially in deep hypothermia circulatory arrest. To provide some clinical data for the application of autologous platelet separation and retransfusion in cardiac surgery. Methods We retrospectively analyzed the period from January 2015 to February 2017. 126 patients underwent ascending aorta and aortic arch surgery in the Department of Cardiovascular surgery, affiliated Hospital of Qingdao University. 104 cases were male and 22 cases were female. The patients were 26 to 76 years old. All patients were divided into two groups. One group was autologous platelet separation group. The other group was non-autologous platelet separation group, the autologous platelet separation group performed autologous platelet separation routine before operation. In the non-autologous platelet separation group, no platelet separation was performed. 51 patients were treated with autologous platelet separation and transfusion. 75 patients with non-autologous platelet separation and transfusion. APRP group was treated with autologous platelet separation technique. Autologous platelets were isolated from patients and stored by shock. The patients were reinfused after protamine neutralization. The blood recovery technique was used only in the non-#en0# group. The relevant indexes before, during and after operation were compared and recorded between the two groups. Finally, the data were analyzed by statistical software. Results during the course of autologous platelet separation, the mean total blood volume of patients was 1350 卤302ml. The separation time was 32 卤12 min, and the average platelet-rich plasma volume was 192 卤43 ml. The platelet concentration in platelet-rich plasma was 802 卤17.6 脳 10 ~ 9 / L. The average platelet content in the isolated platelet-rich plasma was 23 卤3%. A total of 7 patients were excluded, 2 of whom received warfarin or aspirin before operation. Three patients with cardiac function below III grade and two patients with acute aortic dissection with ruptures located in ascending aorta and descending aorta affected the blood flow of abdominal organs. Renal insufficiency or pericardial effusion occurred. 106 patients were included in the study (group 1 35 cases, group 1 71 cases). Statistical analysis of the results of all 106 patients. Preoperative data of the patients were shown in Table 1, of which 72 patients had hypertension. The first group (21) and the second group (51 cases) were diagnosed with coronary heart disease, the first group (3 cases) and the second group (3 cases each). There were 6 cases of Marfan's syndrome and 2 cases of group 1. 4 cases in the second group, 2 cases died in the separation group, 3 cases were discharged automatically, the mortality was 4.6%, 13 cases died in the non-separation group, 5 cases were discharged automatically, and the mortality rate was 20.60.After the exclusion, 13 patients died in the non-separation group and 5 patients left the hospital automatically. 43 patients in the separation group were included in the study, and 63 patients in the non-separation group were included in the study. The use of autologous platelet separation and reinfusion does not significantly increase the amount of intraoperative bleeding and the duration of the operation, but can significantly reduce the early postoperative drainage. Conclusion Autologous platelet separation technique can not significantly increase intraoperative bleeding in patients. It can significantly reduce the early drainage and perioperative blood product consumption in patients with cardiac macrovascular surgery, and also significantly reduce the hospital mortality.
【学位授予单位】：青岛大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R654.2

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