CAJ | 학술논문

目的观察术前自体血小板分离联合术中自体血回输对骨科手术患者凝血功能的影响作用.方法 60例骨科择期手术患者(预计出血量＞1000 ml,ASA Ⅰ～Ⅱ级),随机分为3组,每组20例患者.Ⅰ组采用术前自体血小板分离联合术中自体血回输,Ⅱ组采用单纯术中自体血回输,Ⅲ组不进行任何血液保护措施.各组分别于麻醉前、血小板分离后10 min、保存的血小板或自体血回输前10 min、回输后10 min、术后24 h、术后48 h检测相应时点的血红蛋白水平、凝血功能、血小板水平和聚集功能、术中术后出血量及异体输血情况.结果三组的一般资料、术中出血量、术中术后的血红蛋白水平比较未见明显差异.与Ⅰ组相比,Ⅱ、Ⅲ组术后24 h和术后48 h的血小板水平和聚集功能明显降低(P＜0.05),术后出血量及异体输血率则明显增高(P＜0.01).结论术前自体血小板分离联合术中自体血回输可明显改善骨科手术患者的凝血功能,并有效降低术后出血量和异体血的输注.
목적 관찰술전자체혈소판분리연합술중자체혈회수대골과수술환자응혈공능적영향작용.방법 60례골과택기수술환자(예계출혈량＞1000 ml,ASA Ⅰ～Ⅱ급),수궤분위3조,매조20례환자.Ⅰ조채용술전자체혈소판분리연합술중자체혈회수,Ⅱ조채용단순술중자체혈회수,Ⅲ조불진행임하혈액보호조시.각조분별우마취전、혈소판분리후10 min、보존적혈소판혹자체혈회수전10 min、회수후10 min、술후24 h、술후48 h검측상응시점적혈홍단백수평、응혈공능、혈소판수평화취집공능、술중술후출혈량급이체수혈정황.결과 삼조적일반자료、술중출혈량、술중술후적혈홍단백수평비교미견명현차이.여Ⅰ조상비,Ⅱ、Ⅲ조술후24 h화술후48 h적혈소판수평화취집공능명현강저(P＜0.05),술후출혈량급이체수혈솔칙명현증고(P＜0.01).결론 술전자체혈소판분리연합술중자체혈회수가명현개선골과수술환자적응혈공능,병유효강저술후출혈량화이체혈적수주.
Objective To investigate the effectiveness of preoperative plateletpheresis combined with intraoperative autotransfusion on the blood coagulation of orthopaedic patients.Methods Sixty patients (ASA Ⅰ～Ⅱ)undergoing selective orthopaedic surgery were randomized into three groups(n=20),that is,preoperative plateletpheresis combined with intraoperative autotransfusion for group Ⅰ,intraoperative autotransfusion for group Ⅱ,and group Ⅲ without any managements of blood conservation.Coagulation parameters(prothrombin time,partial thromboplastin time,fibrinogen),hemoglobin and hematocrit values,platelet counts and aggregability were evaluated before the anaestheria,10 minutes after plateletpheresis,10minutes before the infusion of platelet rich plasma or autologous blood,10 minutes after infusion,24 and 48hours postoperation.Intra-and postoperation blood loss and homologous blood transfusion requirements were also recorded.Results Among three groups,there were no differences in intraoperation blood loss,perioperation haemoglobin level(Hb and Hct).As compared with group Ⅰ,significant lower level of platelet counts and aggregability were observed in group Ⅱ and Ⅲ at the time of 24 and 48 hours after operation(P＜0.05),while postoperation blood loss and homologous blood-transfusion requirements increased at the same period(P＜0.01).Conclusions Preoperative plateletpheresis combined with intraoperative autotransfusion can ameliorate the blood coagulation in orthopaedic patients,and it is an effective way to decrease blood loss and homologous blood-transfusions requirements.