摘要目的 评价急性血小板(Plt)分离回输对体外循环(CPB)心脏直视手术患者的血液保护效果.方法 择期拟在CPB下行心脏直视手术患者30例,ASA分级Ⅱ或Ⅲ级,年龄41～63岁,体重52～72 kg.采用随机数字表法,将患者随机分为2组(n=15):对照组(C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索后回输,C组不行APP.于麻醉诱导前、术后1、24和48h时记录Hb、Plt、PT、APTT及Fib.记录CPB时间、主动脉阻断时间、术后引流量和输血情况.结果 APP组急性Plt分离处理的全血容量为(1285±185) ml,采集富Plt血浆(192±38) ml,其中Plt计数(817±282)×10/L,占全身血容量Plt总数(21±3)％,Plt分离时间(35±10) min.与C组比较,APP组术后1h时Plt升高,术后24h内引流量、异体红细胞、Plt输注量和异体Ph输注率降低(P＜0.05或0.01),其余指标差异无统计学意义(P＞0.05).结论 急性Plt分离回输对CPB心脏直视手术患者具有血液保护作用.

abstractsObjective To assess the blood-saving effect of acute plateletpheresis (APP) and back-transfusion in patients undergoing open.heart surgery with CPB.Methods Thirty ASA Ⅱ or Ⅲ patients aged 41-63 yr weighing 52-72 kg undergoing open heart surgery with CPB were randomly divided into 2 groups (n =15 each):control group (group C) and APP group.In APP group,platelet-rich plasma was harvested immediately after induction of anesthesia and transfused back to the patient after termination of CPB and neutralization of heparin with protamine.In group C plateletpheresis was not performed.Hb,Plt,PT,APTT and Fib were measured before induction and at 1,24 and 48 h after operation.CPB time,aortic crossclamping time,postoperative chest tube drainage and blood product transfusion requirements were recorded.Results In APP group the volume of the whole blood processed for plateletpheresis was (1285 ± 185) ml and ( 192 ± 38) ml of platelet-rich plasma was sequestered.The platelet count of the sequestered plasma was(817 ± 282) × 109/L,accounting for (21 ± 3) ％ of the total number of Pit in the whole blood volume.The plateletpheresis took (35 ± 10) min.The platelet count at 1 h after operation was significantly higher in APP group than in group C.The volume of postoperative chest tube drainage at 24 h after operation was significantly lower in APP group than in group C.Less allogeneic RBC and Plt were transfused in APP group than in group C.There was no significant difference in other variables between the 2 groups.Conclusion APP has blood-saving effect in patients undergoing open heart surgery with CPB.