文章摘要
自体血小板分离对Stanford A型夹层全弓置换术患者凝血功能和炎性因子的影响
Effects of autologous platelet separation on coagulation function and inflammatory factors in patients with Stanford type A dissection undergoing total arch replacement
  
DOI：10.12089/jca.2020.03.003
中文关键词: 自体血小板分离术  全弓置换术  凝血功能  炎性因子
英文关键词: Autologous platelet separation  Total arch replacement  Coagulation function  Inflammatory factorsStanford
基金项目:深圳市科创委课题(JCYJ20170307161610240)
作者单位E-mail
王薇 518000,深圳市,中国医学科学院阜外医院深圳医院,深圳市孙逸仙心血管医院麻醉科  
常宁青 518000,深圳市,中国医学科学院阜外医院深圳医院,深圳市孙逸仙心血管医院麻醉科  
张莉 518000,深圳市,中国医学科学院阜外医院深圳医院,深圳市孙逸仙心血管医院麻醉科  
白松杰 518000,深圳市,中国医学科学院阜外医院深圳医院,深圳市孙逸仙心血管医院麻醉科  
黄志勇 518000,深圳市,中国医学科学院阜外医院深圳医院,深圳市孙逸仙心血管医院麻醉科 869093030@qq.com 
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中文摘要:
      
目的 将自体血小板分离结合自体血回收技术应用于Stanford A型主动脉夹层全弓置换术患者,探讨其对凝血功能和炎性因子的影响。
方法 选择2017年7月至2018年12月收治的Stanford A型主动脉夹层行全弓置换术患者40例,男27例,女13例,年龄23~64岁,BMI 20~39 kg/m2,ASA Ⅲ或Ⅳ级。随机分为自体血小板分离结合自体血回收组(APP组,n=25)和单纯自体血回收组(C组,n=15)。记录APP组自体血小板分离量、两组洗涤红细胞回输量、两组术中和术后24 h异体血使用量。记录麻醉诱导后(T0)、肝素化前(T1)、离室前(T2)、术后24 h(T3)红细胞压积(Hct)、血小板计数(Plt),记录反应时间(R)、凝集时间(K)、血凝块形成速率(α角)、血栓最大振幅(MA)、MA后30 min血凝块溶解百分率(ly30)等血栓弹力图(TEG)指标,记录凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、纤维蛋白原(FIB)等凝血功能指标和白细胞介素-2(IL-2)、白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)、前列腺素E2(PGE2)等血清炎性指标。
结果 APP组术中出血量，洗涤红细胞回输量，异体红细胞、血浆和血小板输入量均明显少于C组（P<0.05）。T2—T3时APP组Plt明显高于C组(P<0.05)。T3时APP组R、K明显短于C组,α角、MA 和ly30明显大于C组(P<0.05)。T2—T3时APP组PT、APTT明显短于C组,FIB明显高于C组(P<0.05)。T1—T3时APP组IL-2、IL-6、PGE2明显低于C组(P<0.05)。
结论 全弓置换术患者术前行自体血小板分离能改善凝血功能,减少围术期出血量和异体血输入量,提升血液保护效果;同时降低血清炎性因子水平,改善患者术后炎症反应。
英文摘要:
      
Objective To investigate the effects of autologous platelet separation combined with autologous blood recovery technology on coagulation function and inflammatory factors in patients with Stanford type A aortic dissection undergoing total arch replacement.
Methods Forty patients with Stanford Aortic dissection,27 males and 13 females, aged 23-64 years, BMI 20-39 kg/m2, falling into ASA physical status Ⅲ or Ⅳ,underwent total arch replacement from July 2017 to December 2018, were selected and randomly divided into two groups: autologous platelet separation combined with autologous blood collection group (group APP, n=25) and autologous blood collection group (group C, n=15). The amount of autologous platelet separation in the group APP, the amount of washing red blood transfusion in the two groups, and the amount of allogeneic blood in the two groups within 24 h were recorded. The hematocrit (Hct) and platelet count (Plt) in the two groups, reaction time (R), coagulation time (K), clot formation rate (α angle), thrombus maximum amplitude (MA), the reduction percentage of amplitude 30 minutes after MA (ly30) and other thrombelastogram indicators, prothrombin time (PT), activated partial thromboplastin time (APTT), fibrinogen (FIB) and other coagulation function indicators, interleukin-2 (IL-2), interleukin-6 (IL-6), tumor necrosis factor-alpha (TNF-α),prostaglandin E2 (PGE2) and other serum inflammatory indicators in the two groups were recorded at four time points: after induction (T0), before heparinization (T1),before ventricular detachment (T2) and 24 h after operation (T3).
Results The amount of intraoperative bleeding, washing red blood cells transfusion and allogeneic red blood cells, plasma infusion and platelet infusion in group APP were significantly lower than those in group C (P < 0.05). From T2 to T3, Plt in group APP was significantly higher than that in group C (P < 0.05). R and K in group APP were significantly lower than those in group C at T3 (P < 0.05), while Angle α, MA and Ly30 were significantly higher than those in group C (P < 0.05). From T2 to T3, PT and APTT in group APP were significantly shorter than those in group C, and FIB was significantly higher than that in group C. From T1 to T3, IL-2, IL-6 and PGE2 of group APP were significantly lower than those of group C(P < 0.05).
Conclusion Preoperative autologous platelet separation in patients with Stanford type A aortic dissection undergoing total arch replacementcan improve coagulation function, reduce perioperative bleeding and allogeneic blood input and improve blood protection, and reduce the level of serum inflammatory factors and improve the postoperative inflammatory response.
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