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.	?馬志高, 金沐, 程衛平, 等. 急性主動脈夾層并發急性肺損傷的研究進展. 心肺血管病雜志, 2015, 34(4): 319-321.
2.	朱俊明, 李炳, 梁岳培, 等. 妊娠合并急性 A 型主動脈夾層的外科治療. 中華胸心血管外科雜志, 2012, 28(6): 336-339.
3.	王亮, 常謙, 于存濤, 等. Stanford A 型主動脈夾層術后院內死亡危險因素分析. 中華外科雜志, 2012, 50(5): 422-425.
4.	李菲, 劉楠, 董平, 等. A 型主動脈夾層術后行連續性腎臟替代治療患者死亡危險因素分析. 心肺血管病雜志, 2014, 33(6): 834-837.
5.	尚蔚, 劉楠, 閆曉蕾, 等. A 型主動脈夾層手術后發生呼吸功能不全的危險因素分析. 中華胸心血管外科雜志, 2011, 27(6): 349-352.
6.	徐建紅, 張雄信, 陳寒, 等. Stanford A 型主動脈夾層手術的麻醉管理. 中華醫學雜志, 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. 富血小板血漿分離與急性等容性血液稀釋血液保護效果的對比研究. 中國體外循環雜志, 2013, 11(4): 213-216.
9.	魏海燕, 史宏偉, 鮑紅光, 等. 急性血小板分離回輸對體外循環心臟直視手術患者的血液保護效果. 中華麻醉學雜志, 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, 史宏偉, 等. 急性血小板分離制備心臟手術患者富血小板血漿的質量分析. 中國實驗血液學雜志, 2014, 22(2): 52l-524.
13.	黃長順, 潘志浩, 徐煒烽, 等. 術前急性自體血小板分離對心臟手術患者血小板活化功能的影響. 中華輸血雜志, 2006, 19(1): 45-47.
14.	徐美英, 張富強, 朱文忠, 等. 心臟手術中凝血及血小板功能的變化. 中華麻醉學雜志, 2001, 21(10): 607-610.

1. ?馬志高, 金沐, 程衛平, 等. 急性主動脈夾層并發急性肺損傷的研究進展. 心肺血管病雜志, 2015, 34(4): 319-321.
2. 朱俊明, 李炳, 梁岳培, 等. 妊娠合并急性 A 型主動脈夾層的外科治療. 中華胸心血管外科雜志, 2012, 28(6): 336-339.
3. 王亮, 常謙, 于存濤, 等. Stanford A 型主動脈夾層術后院內死亡危險因素分析. 中華外科雜志, 2012, 50(5): 422-425.
4. 李菲, 劉楠, 董平, 等. A 型主動脈夾層術后行連續性腎臟替代治療患者死亡危險因素分析. 心肺血管病雜志, 2014, 33(6): 834-837.
5. 尚蔚, 劉楠, 閆曉蕾, 等. A 型主動脈夾層手術后發生呼吸功能不全的危險因素分析. 中華胸心血管外科雜志, 2011, 27(6): 349-352.
6. 徐建紅, 張雄信, 陳寒, 等. Stanford A 型主動脈夾層手術的麻醉管理. 中華醫學雜志, 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. 富血小板血漿分離與急性等容性血液稀釋血液保護效果的對比研究. 中國體外循環雜志, 2013, 11(4): 213-216.
9. 魏海燕, 史宏偉, 鮑紅光, 等. 急性血小板分離回輸對體外循環心臟直視手術患者的血液保護效果. 中華麻醉學雜志, 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, 史宏偉, 等. 急性血小板分離制備心臟手術患者富血小板血漿的質量分析. 中國實驗血液學雜志, 2014, 22(2): 52l-524.
13. 黃長順, 潘志浩, 徐煒烽, 等. 術前急性自體血小板分離對心臟手術患者血小板活化功能的影響. 中華輸血雜志, 2006, 19(1): 45-47.
14. 徐美英, 張富強, 朱文忠, 等. 心臟手術中凝血及血小板功能的變化. 中華麻醉學雜志, 2001, 21(10): 607-610.

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Protective effect of autologous platelet separation on blood in surgery for Standford type A aortic dissection: A randomized controlled trial

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