本文關鍵詞： 自體血小板分離 心臟大血管手術 深低溫 體外循環(huán)　出處：《青島大學》2017年碩士論文　論文類型：學位論文

【摘要】：目的探討自體血小板分離技術在心外科大血管手術特別是深低溫停循環(huán)手術中的臨床價值,為自體血小板分離回輸技術在心外科的應用提供一定的臨床數據支持。方法我們回顧性的分析了在2015年1月到2017年2月期間,于青島大學附屬醫(yī)院心血管外科行升主動脈及主動脈弓手術的患者126例。其中男性患者104人,女性22人�；颊吣挲g在26-76歲,平均(53.72+10.99)歲。所有患者被分為兩組。一組為自體血小板分離組,另一組為非自體血小板分離組。自體血小板分離組在術前常規(guī)行自體血小板分離程序,非自體血小板分離組則未行血小板的分離操作。采用自體血小板分離并回輸的患者51例,非自體血小板分離回輸的患者75例。APRP組術中采用自體血小板分離技術,分離患者自體血小板并震蕩保存,于魚精蛋白中和后回輸患者,非APRP組僅采用血液回收技術。比較兩組患者術前、術中及術后的相關指標并記錄,最后應用統(tǒng)計學軟件來進行數據分析。結果術前進行自體血小板分離的過程中,平均采集患者的全血量(1350±302)ml,分離耗時(32±12)min,平均分離得到的患者富血小板血漿量(192±43)ml,其中,富血小板血漿中含有的血小板濃度為(802±176)×109/L,分離出的富血小板血漿中血小板含量占全身血小板總數平均值為(23±3%)�？傆�7例患者被排除在外,其中,2例患者術前應用了華法林或阿司匹林、波立維等抗凝藥物,3例患者心功能在III級以下,另有2例患者為急性的主動脈夾層,破口位于升主動脈及降主動脈,且破口影響了患者腹腔臟器的血運,出現了腎功能不全或心包積液的情況。最終有106名患者被納入本研究(第一組35例,第一組71例),對所有106名患者的結果統(tǒng)計分析�；颊叩男g前資料如表1所示,其中,72例患者患有高血壓,其中第一組(21%)和第二組(51%)。6例病人被診斷為冠心病,第一組及第二組各3例。有6例馬凡氏綜合癥的患者,第一組2例,第二組4例。分離組死亡2例,自動出院3例,死亡率4.6%,非分離組死亡13人,自動出院5人,死亡率20.6%。經排除后,分離組有43例患者被納入研究,非分離組有63例患者被納入研究。分析兩組患者的術后統(tǒng)計資料發(fā)現,使用自體血小板分離回輸技術并不會明顯增加患者的術中的出血量及手術時長,但是可以明顯降低患者術后早期的引流量、輸血制品的費用等指標。結論自體血小板分離技術在不顯著增加患者術中出血的前提下,可以明顯降低心臟大血管手術患者術后早期引流量及圍術期的血制品用量,并且,顯著降低患者的院內死亡率。
[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 鹵302ml. The separation time was 32 鹵12 min, and the average platelet-rich plasma volume was 192 鹵43 ml. The platelet concentration in platelet-rich plasma was 802 鹵17.6 脳 10 ~ 9 / L. The average platelet content in the isolated platelet-rich plasma was 23 鹵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.
【學位授予單位】：青島大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R654.2

【參考文獻】

相關期刊論文 前10條

1 臧旺福;李沅敏;周健;周耀銓;韓晨俊;仇鋒;;血小板分離回輸對心臟外科手術患者血小板和凝血功能的影響[J];國際心血管病雜志;2017年01期

2 鄧麗;劉宗泓;楊慧;孫博;劉宏宇;;自體血小板分離回輸減少主動脈夾層手術圍術期異體血制品用量[J];中國體外循環(huán)雜志;2016年04期

3 顏翩翩;賴可可;朱鵬;楊謙;;術前自體血小板分離回輸在非體外循環(huán)下冠狀動脈旁路移植術中的應用[J];國際麻醉學與復蘇雜志;2016年12期

4 王永旺;喻文立;王清平;翁亦齊;杜洪印;王剛;于泳浩;;急性血小板分離或自體血回輸對體外循環(huán)冠狀動脈旁路移植術患者血液保護的影響[J];天津醫(yī)科大學學報;2016年06期

5 袁輝;黃維勤;袁世熒;;自體血小板分離在大血管手術中的血液保護作用[J];中國心血管病研究;2016年11期

6 羅智超;彭東;周成斌;鐘執(zhí)文;林中林;章曉華;范瑞新;;自體血小板分離技術在全弓置換術中的初步應用[J];中國體外循環(huán)雜志;2016年03期

7 林培容;侯宇希;趙嘉美;樊珍;趙麗云;馬駿;;自體血小板分離回輸對復雜主動脈弓部手術患者圍術期全身炎性反應的影響[J];心肺血管病雜志;2016年06期

8 趙嘉美;趙麗云;卿恩明;;自體血小板分離技術在大血管手術中的應用[J];心肺血管病雜志;2016年06期

9 汪雍媛;紀宏文;;自體血小板分離對深低溫停循環(huán)主動脈手術的血液保護作用[J];中國輸血雜志;2016年04期

10 林培容;侯宇希;趙麗云;馬駿;;急性血小板分離技術對深低溫停循環(huán)主動脈手術患者凝血功能的影響[J];臨床麻醉學雜志;2016年05期

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