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非体外循环下冠脉搭桥术中应用自体血回输对患者术后凝血功能的影响
The Influence of Intraoperative Cell Salvage On Coagulation Function During Off-pump Coronary Artery Bypass Grafting
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DOI:
作者:
王森森,沈杰,薛庆生,于布为
WANG Sensen, SHEN Jie, XUE Qingsheng, YU Buwei
作者单位:
上海交通大学医学院附属瑞金医院麻醉科
Department of Anesthesiology, Ruijin Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai 200025, PR China
关键词:
自体血回输,非体外循环下冠脉搭桥手术,凝血功能
Cell salvage, Off-pump coronary artery bypass grafting, Coagulation function
摘要:
目的:前瞻性评价非体外循环下冠脉搭桥术中应用自体血回输对手术患者术后凝血功能的影响。方法:连续入选46例ASA I~III级非体外循环下冠状动脉搭桥术中使用自体血回输的患者,比较术前及术后24小时的凝血功能、血小板数量及功能、肾功能,观测术后24小时引流总量及其影响因素,以评价自体血回输对非体外循环下冠脉搭桥术患者术后凝血功能的影响。 结果:与术前凝血功能相比,术后24小时PT(13.0±1.0s比11.4±0.9s,P﹤0.01)、APTT(32.0±3.3s比30.2±3.0s,P﹤0.01)、INR(1.1±0.1比1.0±0.3,P﹤0.05)均显著升高,而PLT[(150.8±57.5)×109/L比(179.4±55.9)×109/L,P﹤0.01]及Fg(2.6±0.6g/l比3.5±0.6g/l,P﹤0.01)均显著降低。但ADP诱导的血小板聚集力1min(39.7±10.6比38.3±13.9,P﹥0.05)、5min(47.7±16.4比45.7±20.6,P﹥0.05)及最大值(51.5±16.0比49.8±19.5,P﹥0.05)、血肌酐(81.3±23.2比80.2±14.8,P﹥0.05)术前与术后24小时相比无统计学差异。多因素线性回归分析显示,术后24小时引流总量与自体血回输量无显著相关性(R=0.056,P﹥0.05)。结论:术中自体血回输不增加非体外循环下冠脉搭桥术患者术后的出血风险,对血小板相关的凝血无显著影响,但对凝血酶相关的凝血存在一定的影响。
Objective: This prospective study was designed to evaluate the influence of intraoperative cell salvage on coagulation function during off-pump coronary artery bypass grafting (OPCABG). Methods: Forty-Six ASA I~III patients, who received OPCABG with intraoperative cell salvage, were included in the study. By comparing coagulation function, platelet amount and function, renal function before and 24 hours after surgery, as well as observing the amount of drainage 24 hours after surgery, the influence of intraoperative cell salvage on coagulation function during OPCABG were assessed. Results: Compared with the coagulation function before OPCABG, PT (13.0±1.0s vs 11.4±0.9s, P﹤0.01), APTT (32.0±3.3s vs 30.2±3.0s, P﹤0.01) and INR (1.1±0.1 vs 1.0±0.3, P﹤0.05) 24 hours after surgery were significantly increased. PLT [(150.8±57.5)×109/L vs (179.4±55.9)×109/L, P﹤0.01)] and Fg (2.6±0.6g/l vs 3.5±0.6g/l, P﹤0.01) differed significantly between before and 24 hours after OPCABG. ADP-induced aggregation function of platelet at 1 minute (39.7±10.6 vs 38.3±13.9, P﹥0.05), 5 minutes (47.7±16.4 vs 45.7±20.6, P﹥0.05) and maximum (51.5±16.0 vs 49.8±19.5, P﹥0.05) were similar, as well as creatinine clearance (81.3±23.2 vs 80.2±14.8, P﹥0.05). Multivariate linear regression revealed there was no relevance between postoperative drainage and cell salvage usage (R=0.056,P﹥0.05). Conclusion: Cell salvage has no influence on the risk of postoperative hemorrhage or platelet coagulation function in patients undergoing OPCABG, except thrombin coagulation function.
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