Protective effect of autologous platelet separation on blood in surgery for Standford type A aortic dissection: A randomized controlled trial_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

YUANHui ¹ ,  HUANGWeiqin ¹ , LUOGang ¹ , WANGYulin ¹ , CHENGYuhua ¹ , YUANShiying ²

1. Department of Anesthesiology, Wuhan Asia Heart Hospital, Wuhan, 430022, P.R.China;
2. Department of Anesthesiology, Xiehe Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, P.R.China;

Corresponding author：

HUANGWeiqin, Email: hwq2010@139.com

Keywords：

Autologous plateletpheresis; cardiopulmonary bypass; major vascular surgery; blood conservation

DOI：

10.7507/1007-4848.201605033

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Objective To investigate the protective effect of autologous platelet separation on blood in surgery for Standford type A aortic dissection. Methods A total of 180 patients with Standford type A aortic dissection undergoing elective major vascular surgery in our hospital from July 2014 to March 2016 were enrolled. There were 123 males and 57 females with age ranging from 19 to 68 years and weight of 50-85 kg. The patients were randomly divided into two groups. Patients in group A (n=92, 65 males, 27 females, mean age of 45±21 years) received intraoperative autologous blood recovery; while those in group B (n=88, 58 males, 30 females, mean age of 43±24 years) received autologous platelet rich plasma (APRP) and intraoperative autologous blood recovery. The whole process of platelet separation was completed before heparinization. The relevant indicators of blood coagulation function before the induction of anesthesia (T₁), before heparinization (T₂), immediately postoperatively (T₃) and 1 h (T₄), 24 h (T₅) postoperatively were measured. Cardiopulmonary bypass, aortic cross-clamping time, drainage volume at postoperative 1 h, 24 h and allogeneic blood transfusion volume were recorded. Results The whole blood volume of group B in the platelet separation in emergency was 1 305±110 ml, and collected platelet rich plasma was 275±30 ml, platelet counts (630±220)×10⁹/L, accounting for 25%±5% of platelets of whole blood, and platelet separation time was 32±9 min. Compared with group A, platelet count at postoperative 1 h in group B was significantly higher; drainage volume at postoperative 1 h, 24 h, allogeneic red blood cells, plasma transfusion volume and allogeneic platelet infusion rate decreased significantly (P<0.05). Group B had less postoperative complications (P<0.05). Conclusion Preoperative autologous plateletpheresis combined with intraoperative autologous blood recovery can significantly improve the coagulation function of patients with vascular surgery, and reduce the amount of allogeneic blood transfusion and postoperative bleeding.

Citation： YUANHui, HUANGWeiqin, LUOGang, WANGYulin, CHENGYuhua, YUANShiying. Protective effect of autologous platelet separation on blood in surgery for Standford type A aortic dissection: A randomized controlled trial. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2017, 24(2): 104-109. doi: 10.7507/1007-4848.201605033 Copy

1.	马志高, 金沐, 程卫平, 等. 急性主动脉夹层并发急性肺损伤的研究进展. 心肺血管病杂志, 2015, 34(4): 319-321.
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3.	王亮, 常谦, 于存涛, 等. Stanford A 型主动脉夹层术后院内死亡危险因素分析. 中华外科杂志, 2012, 50(5): 422-425.
4.	李菲, 刘楠, 董平, 等. A 型主动脉夹层术后行连续性肾脏替代治疗患者死亡危险因素分析. 心肺血管病杂志, 2014, 33(6): 834-837.
5.	尚蔚, 刘楠, 闫晓蕾, 等. A 型主动脉夹层手术后发生呼吸功能不全的危险因素分析. 中华胸心血管外科杂志, 2011, 27(6): 349-352.
6.	徐建红, 张雄信, 陈寒, 等. Stanford A 型主动脉夹层手术的麻醉管理. 中华医学杂志, 2012, 92(41): 2905-2908.
7.	Weber CF, Dietrich W, Spannaql M, et al. A point-of-care assessment of the effects of desmopressin on impaired platelet function using multiple electrode whole-blood aggregometry in patients after cardiac surgery. Anesth Analg, 2010, 110(3): 702-707.
8.	王中, 薛玉良, 王洪武, 等. 富血小板血浆分离与急性等容性血液稀释血液保护效果的对比研究. 中国体外循环杂志, 2013, 11(4): 213-216.
9.	魏海燕, 史宏伟, 鲍红光, 等. 急性血小板分离回输对体外循环心脏直视手术患者的血液保护效果. 中华麻醉学杂志, 2011, 31(17): 812-815.
10.	Harrison P. Platelet function analysis. Blood Rev, 2005, 19(2): 111-123.
11.	Ganter MT, Monn A, Tavakoli R, et al. Kaolin-based activated coagulation time measured by sonoclot in patients undergoing cardiopulmonary bypass. Cardiothorac Vasc Anesth, 2007, 21(4): 524-528.
12.	魏海燕, 丁正年, 史宏伟, 等. 急性血小板分离制备心脏手术患者富血小板血浆的质量分析. 中国实验血液学杂志, 2014, 22(2): 52l-524.
13.	黄长顺, 潘志浩, 徐炜烽, 等. 术前急性自体血小板分离对心脏手术患者血小板活化功能的影响. 中华输血杂志, 2006, 19(1): 45-47.
14.	徐美英, 张富强, 朱文忠, 等. 心脏手术中凝血及血小板功能的变化. 中华麻醉学杂志, 2001, 21(10): 607-610.

1. 马志高, 金沐, 程卫平, 等. 急性主动脉夹层并发急性肺损伤的研究进展. 心肺血管病杂志, 2015, 34(4): 319-321.
2. 朱俊明, 李炳, 梁岳培, 等. 妊娠合并急性 A 型主动脉夹层的外科治疗. 中华胸心血管外科杂志, 2012, 28(6): 336-339.
3. 王亮, 常谦, 于存涛, 等. Stanford A 型主动脉夹层术后院内死亡危险因素分析. 中华外科杂志, 2012, 50(5): 422-425.
4. 李菲, 刘楠, 董平, 等. A 型主动脉夹层术后行连续性肾脏替代治疗患者死亡危险因素分析. 心肺血管病杂志, 2014, 33(6): 834-837.
5. 尚蔚, 刘楠, 闫晓蕾, 等. A 型主动脉夹层手术后发生呼吸功能不全的危险因素分析. 中华胸心血管外科杂志, 2011, 27(6): 349-352.
6. 徐建红, 张雄信, 陈寒, 等. Stanford A 型主动脉夹层手术的麻醉管理. 中华医学杂志, 2012, 92(41): 2905-2908.
7. Weber CF, Dietrich W, Spannaql M, et al. A point-of-care assessment of the effects of desmopressin on impaired platelet function using multiple electrode whole-blood aggregometry in patients after cardiac surgery. Anesth Analg, 2010, 110(3): 702-707.
8. 王中, 薛玉良, 王洪武, 等. 富血小板血浆分离与急性等容性血液稀释血液保护效果的对比研究. 中国体外循环杂志, 2013, 11(4): 213-216.
9. 魏海燕, 史宏伟, 鲍红光, 等. 急性血小板分离回输对体外循环心脏直视手术患者的血液保护效果. 中华麻醉学杂志, 2011, 31(17): 812-815.
10. Harrison P. Platelet function analysis. Blood Rev, 2005, 19(2): 111-123.
11. Ganter MT, Monn A, Tavakoli R, et al. Kaolin-based activated coagulation time measured by sonoclot in patients undergoing cardiopulmonary bypass. Cardiothorac Vasc Anesth, 2007, 21(4): 524-528.
12. 魏海燕, 丁正年, 史宏伟, 等. 急性血小板分离制备心脏手术患者富血小板血浆的质量分析. 中国实验血液学杂志, 2014, 22(2): 52l-524.
13. 黄长顺, 潘志浩, 徐炜烽, 等. 术前急性自体血小板分离对心脏手术患者血小板活化功能的影响. 中华输血杂志, 2006, 19(1): 45-47.
14. 徐美英, 张富强, 朱文忠, 等. 心脏手术中凝血及血小板功能的变化. 中华麻醉学杂志, 2001, 21(10): 607-610.

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