摘要
目的评价自体富血小板血浆(aPRP)对孙氏手术患者术后转归的影响。方法选择急性斯坦福A型主动脉夹层患者116例,性别不限,年龄18~64岁,体重指数19~34 kg/m^2,ASA分级Ⅳ级。采用随机数字表法分为自体富血小板血浆组(A组)和对照组(C组),每组58例。麻醉诱导和气管插管后,A组于手术开始前完成aPRP制备,C组开始手术。中和肝素后,A组回输自体富血小板血浆,C组接受常规容量管理。所有患者均行血栓弹力图检查并记录结果。记录2组患者术中异体血制品用量和出血量。于麻醉诱导后(T0)、自体富血小板血浆制备完成后即刻(T1)、中和肝素后3 h(T2)、术后24和48 h(T3,4)时测定血浆TNF-α和IL-6浓度,记录术后胸管引流量和异体血制品用量、机械通气时间、ICU停留时间、住院时间、30 d内重要并发症发生率和病死率。结果与C组比较,A组患者术中异体血制品用量和出血量明显减少,血栓弹力图α角和MA值较大,T2,3时血浆TNF-α和IL-6浓度减低,术后胸管引流量和异体血用量减少,术后机械通气时间和住院时间缩短,肺部并发症发生率降低(P<0.05)。2组患者ICU停留时间、术后30 d其它并发症发生率和病死率差异无统计学意义(P>0.05)。结论aPRP可改善孙氏手术患者术后转归。
Objective To evaluate the effect of autologous platelet-rich plasma(aPRP)on postoperative outcomes in the patients undergoing Sun′s procedure.Methods One hundred and sixteen patients with acute Stanford type A aortic dissection of both sexes,aged 18-64 yr,with body mass index of 19-34 kg/m^2,of American Society of Anesthesiologist physical statusⅣ,were divided into aPRP group(group A)and control group(group C)by a random number table method,with 58 cases in each group.After anesthesia induction and intubation,aPRP preparation was completed before surgery in group A,and surgery began in group C.After heparin neutralization,group A received retransfusion of platelet-rich plasma,while group C received conventional fluid management.Thromboelastography was performed on all patients,and the results were recorded.The intraoperative amount of allogeneic blood products and blood loss were recorded in two groups.Plasma concentrations of tumor necrosis factor-alpha(TNF-α)and interleukin-6(IL-6)were recorded after anesthesia induction(T0),immediately after completion of aPRP preparation(T1),3 h after heparin neutralization(T2),and at 24 and 48 h after surgery(T3,4).The volume of postoperative chest drainage and amount of allogeneic blood products,mechanical ventilation time,lengths of intensive care unit and hospital stay,incidence of important complications and fatality rate within 30 days after surgery were also collected.Results Compared with group C,the intraoperative amount of allogeneic blood products and blood loss were significantly reduced,αangle and MA values of thromboelastograph were larger,plasma concentrations of TNF-αand IL-6 were reduced at T2,3,postoperative chest drainage volume and allogeneic blood transfusion were reduced,the postoperative mechanical ventilation time and length of hospital stay were shortened,and the incidence of pulmonary complications was reduced in group A(P<0.05).There was no significant difference in the length of intensive care unit stay,incidence of other complications or fatality rate within 30 days after surgery between the two groups(P>0.05).Conclusion aPRP can improve postoperative outcomes in the patients undergoing Sun′s procedure.
作者
田文智
耳建旭
刘亮
陈庆良
韩建阁
Tian Wenzhi;Er Jianxu;Liu Liang;Chen Qingliang;Han Jiange(Department of Anesthesiology,Tianjin Chest Hospital,Tianjin Cardiovascular Diseases Institute,Tianjin 300051,China;Department of Cardiovascular Surgery,Tianjin Chest Hospital,Tianjin Cardiovascular Diseases Institute,Tianjin 300051,China)
出处
《中华麻醉学杂志》
CAS
CSCD
北大核心
2019年第10期1216-1220,共5页
Chinese Journal of Anesthesiology
关键词
富血小板血浆
动脉瘤
夹层
预后
Platelet-rich plasma
Aneurysm
dissecting
Prognosis
