2019 年第 4 期 第 14 卷

不同自体血分离量对急性主动脉夹层大血管手术患者凝血功能的影响分析

Effect of different autologous blood separation ratio on coagulation function in patients undergoing acute aortic dissection surgery

作者：何琛裴馨赵丽云马骏

英文作者：

单位：100029首都医科大学附属北京安贞医院麻醉中心北京市心肺血管疾病研究所

英文单位：

关键词：急性主动脉夹层；自体血小板分离；自体血分离量；凝血功能

英文关键词：

• 摘要：

• 【摘要】目的    分析不同自体血分离量对经历深低温停循环的急性主动脉夹层大血管手术患者围术期凝血功能的影响。方法    回顾性分析首都医科大学附属安贞医院2015年9月至2018年5月诊断为急性A型主动脉夹层并在深低温停循环下行主动脉根部替换(Bentall)及全弓替换加支架象鼻术(孙氏手术)治疗的270例患者的临床资料，根据自体血分离量将患者分为A组（＜15 ml/kg，94例）、B组（15～20 ml/kg，91例）、C组（＞20 ml/kg，85例）。收集患者手术前后实验室血常规及凝血功能检查指标。计算术中输液量、出血量、手术时间等指标。统计术中及术后患者悬浮红细胞、血浆、血小板的输注总量。结果    与A组相比，B组和C组术中出血量、输红细胞例数、输血浆的例数及量、洗涤红细胞量均明显减少，差异均有统计学意义（均P＜0.05）。B组和C组较A组术后活化部分凝血活酶时间明显缩短，术后输红细胞、血浆、血小板的例数明显减少，输血小板的量也明显减少［（33±6）、（33±6）s比（36±6）s，58.2%（53/91）、63.5%（54/85）比72.3%（68/94），22.0%（20/91）、24.7%（21/85）比37.2%（35/94），27.5%（25/91）、39.4%（25/85）比41.5%（39/94），1(1,1)、1(1,1)U比1(1,2)U］，差异均有统计学意义（均P＜0.05）。B组与C组术后凝血功能、异体血输注量及例数差异无统计学意义（P＞0.05）。结论    15～20 ml/kg的自体血分离量在急性主动脉夹层手术中可起到血液保护作用,＞20 ml/kg的自体血分离量在血液保护方面作用与15~20 ml/kg相当，未见明显优势。

• 【Abstract】Objective    To analyze the effect of different autologous blood separation ratio on coagulation function in patients undergoing acute aortic dissection surgery with deep hypothermic circulatory arrest. Methods    Clinical data of 270 patients who underwent acute type A aortic dissection surgery（Bentall＋Sun′s surgery） under deep hypothermic circulatory arrest in Beijing Anzhen Hospital, Capital Medical University Between September 2015 to May 2018 were retrospectively analyzed. According to autologous blood separation ratio, the patients were divided into group A(＜15 ml/kg, 94 cases), group B(15-20 ml/kg, 91 cases) and group C(＞20 ml/kg, 85 cases). Blood routine and coagulation indexes before and after surgery, intraoperative transfusion volume, blood loss and operative time were recorded. Transfusion volumes of suspended red blood cell, plasma and platelet during and after surgery were calculated. Results    Intraoperative blood loss, red blood cell transfusion rate, plasma transfusion rate, plasma transfusion volume and washed red blood cell volume in group B and C were significantly less than those in group A（all P＜0.05）. After surgery, activated partial thromboplastin time was significantly shorter, transfusion rates of red blood cell, plasma, platelet and transfusion volume of platelet were significantly less in group B and C than those in group A［（33±6）,（33±6）s vs （36±6）s; 58.2%（53/91）, 63.5%（54/85） vs 72.3%（68/94）; 22.0%（20/91）, 24.7%（21/85） vs 37.2%（35/94）; 27.5%（25/91）, 39.4%（25/85） vs 41.5%（39/94）; 1(1,1), 1(1,1)U vs 1(1,2)U］（all P＜0.05）. There was no significant difference in postoperative coagulation function and allogeneic blood transfusion data between group B and group C（P＞0.05）. Conclusion    Autologous blood separation of 15-20 ml/kg plays a protective role in acute aortic dissection surgery; ＞20 ml/kg autologous blood separation shows no obvious advantage.