Effect of different levels of MAPP on lung function protection and coagulation function in patients undergoing heart valve replacement surgery
-
摘要: 目的 探讨不同改良自体血小板分离(MAPP)量对心脏瓣膜置换手术患者肺功能保护及凝血功能的影响。方法 纳入2019年1月—2023年1月医院住院成人心脏瓣膜病95例患者进行前瞻性随机对照试验。根据随机数字表分成3组：A组(MAPP＜10 mL/kg)31例、B组(MAPP为10~15 mL/kg)32例、C组(MAPP>15 mL/kg)32例。比较3组凝血功能及术后72 h内急性肺损伤发生情况。结果 研究过程中剔除各组MAPP分离至目标量前红细胞比容持续＜20%者，每组均有30例患者进入研究。与A组比较，B、C组在体外循环结束即刻(L3)时活化部分凝血酶原时间(APTT)明显延长，血浆纤维蛋白原(Fib)浓度升高(P＜0.05)，但B组和C组L3时APTT、Fib值比较，差异无统计学意义(P>0.05)；B组和C组L3、术后1 h(L4)、24 h(L5)时最大血块强度(MA)值均高于A组(P＜0.05)，但B组和C组L3、L4、L5时MA值比较，差异无统计学意义(P>0.05)。A组术后72 h急性肺损伤发生率为6.67%，B组为3.33%，C组为10.00%。3组急性肺损伤发生率比较，差异无统计学意义(χ2=1.012，P=0.868)。结论 10~15 mL/kg MAPP分离量对改善心脏瓣膜置换手术患者的凝血功能最佳，同时该分离量不会增加急性肺损伤发生率。Abstract: Objective To investigate the effects of different levels of modified autologous platelet-rich plasmapheresis(MAPP) on lung function protection and coagulation function in patients undergoing heart valve replacement surgery.Methods A prospective randomized controlled trial was conducted on 95 adult patients with valvular heart disease admitted to our Hospital from January 2019 to January 2023. According to a random number table, they were randomly divided into three groups: Group A(MAPP < 10 mL/kg) with 31 cases, Group B(MAPP 10-15 mL/kg) with 32 cases and Group C(MAPP>15 mL/kg) with 32 cases. The effect of different levels of MAPP on lung function protection and coagulation function in patients undergoing double valve replacement surgery was analyzed.Results During the study, patients with hematocrit < 20% before MAPP separation to the target volume were excluded, and 30 patients in each group were enrolled in the study. Compared with Group A, Group B and Group C significantly prolonged the activated partial prothrombin time(APTT) and increased plasma fibrinogen(FIB) concentration immediately after the end of cardiopulmonary bypass(L3)(P < 0.05). However, there was no statistical significant difference in APTT and FIB values between Group B and Group C at L3(P>0.05). The maximum blood clot strength(MA) values at L3, 1 hour(L4), and 24 hours(L5) after surgery in Group B and Group C were higher than those in Group A(P < 0.05), but there was no statistical significant difference in MA values between Group B and Group C at L3, L4, and L5(P>0.05). The incidence of acute lung injury at 72 h after operation in group A, B, C was 3.33%, 6.67% and 10.00%. There was no statistical significant difference in the incidence of acute lung injury among the three groups(χ2=1.012, P=0.868).Conclusion The separation amount of 10-15 mL/kg MAPP may be the best for improving coagulation function in the patients undergoing heart valve replacement surgery, and the separation amount would not increase the incidence of acute lung injury.
-
-
表 1 3组患者不同时点凝血功能比较
X±S 组别 例数 PT/s L1 L2 L3 L4 L5 L6 A组 30 12.36±2.67 12.64±2.24 15.52±2.17 14.68±2.34 13.56±2.19 13.52±2.16 B组 30 12.33±2.51 12.91±2.30 15.80±2.21 14.57±2.27 13.48±2.34 13.29±2.13 C组 30 12.40±2.62 12.73±2.28 15.67±2.19 14.64±2.31 13.54±2.26 13.51±2.20 F 0.070 0.109 0.147 0.015 0.009 0.161 P 0.993 0.897 0.863 0.985 0.991 0.852 组别 例数 APTT/s L1 L2 L3 L4 L5 L6 A组 30 33.12±4.18 34.21±4.35 44.06±6.72 42.89±8.33 38.27±6.10 37.25±5.35 B组 30 33.28±4.26 34.67±4.42 49.07±6.14 43.00±7.64 39.00±5.62 37.13±5.55 C组 30 33.30±4.24 34.50±4.38 48.67±6.30 42.93±8.12 38.65±6.00 37.20±5.47 F 0.019 0.089 5.801 0.002 0.116 0.003 P 0.981 0.915 0.004 0.998 0.891 0.997 组别 例数 Fib/(g/L) L1 L2 L3 L4 L5 L6 A组 30 3.24±0.63 3.22±0.54 2.03±0.48 2.69±0.47 2.94±0.44 2.96±0.46 B组 30 3.30±0.60 3.18±0.55 2.61±0.50 2.71±0.45 2.98±0.46 3.00±0.49 C组 30 3.27±0.62 3.20±0.51 2.58±0.47 2.70±0.50 2.97±0.48 3.02±0.50 F 0.093 0.045 12.470 0.013 0.057 0.157 P 0.991 0.956 ＜0.001 0.987 0.945 0.855 组别 例数 MA/mm L1 L2 L3 L4 L5 L6 A组 30 60.65±5.76 60.47±6.01 46.63±4.32 46.74±4.29 49.39±4.33 55.52±4.58 B组 30 61.20±5.17 60.54±5.87 50.64±4.51 53.52±4.32 55.67±5.01 55.80±4.61 C组 30 60.87±5.54 60.61±5.92 50.51±4.56 53.56±4.44 55.53±4.86 55.73±4.53 F 0.081 0.004 7.817 24.945 17.584 0.027 P 0.922 0.996 0.001 ＜0.001 ＜0.001 0.973 注：PT：F组间P组间=0.012/0.988；F时点P时点=8.563/0.004；F组间*时点P组间*时点=0.136/0.873；APTT：F组间P组间=1.661/0.196；F时点P时点=75.183/＜0.001；F组间*时点P组间*时点=1.068/0.385；Fib：F组间P组间=3.002/0.055；F时点P时点=34.164/＜0.001；F组间*时点P组间*时点=1.810/0.057；MA：F组间P组间=23.958/＜0.001；F时点P时点=83.572/＜0.001；F组间*时点P组间*时点=3.922/＜0.001。 
下载: 导出CSV
-
[1] Gerstein NS, Panikkath PV, Mirrakhimov AE, et al. Cardiopulmonary bypass emergencies and intraoperative issues[J]. J Cardiothorac Vasc Anesth, 2022, 36(12): 4505-4522. doi: 10.1053/j.jvca.2022.07.011
[2] Nteliopoulos G, Nikolakopoulou Z, Chow BHN, et al. Lung injury following cardiopulmonary bypass: a clinical update[J]. Expert Rev Cardiovasc Ther, 2022, 20(11): 871-880. doi: 10.1080/14779072.2022.2149492
[3] 曾玉鑫, 聂聪, 潘佳浩, 等. 不同时程心脏大血管手术中自体血小板分离回输的临床应用[J]. 中国医师杂志, 2022, 24(4): 577-581.
[4] Xin Y, Peng J, Hong YY, et al. Advances in research on the effects of platelet activation in acute lung injury(Review)[J]. Biomed Rep, 2022, 16(3): 17. doi: 10.3892/br.2022.1500
[5] 常影, 刘泽雄, 季晓鹏, 等. 体外循环肺损伤机制与肺保护策略研究进展[J]. 长春中医药大学学报, 2023, 39(7): 817-821. https://www.cnki.com.cn/Article/CJFDTOTAL-CZXX202307021.htm
[6] 魏海燕, 史宏伟, 李滢, 等. 自体血小板分离回输对急性A型主动脉夹层患者P-选择素和炎性因子的影响[J]. 国际麻醉学与复苏杂志, 2021, 42(7): 712-716.
[7] 王惠, 梁碧霞, 于坤, 等. 改良自体血小板分离技术在心脏手术中应用[J]. 中国体外循环杂志, 2018, 16(5): 273-277.
[8] 陶雨琦, 汪沁, 贺玲, 等. 麻醉前自体血小板保护技术在Stanford A型主动脉夹层手术中的应用1例报道[J]. 现代医药卫生, 2021, 37(10): 1785-1787. https://www.cnki.com.cn/Article/CJFDTOTAL-XYWS202110061.htm
[9] 裴馨, 何琛, 谢思远, 等. 不同自体血小板分离量对中低温停循环急性主动脉夹层手术患者肺功能的影响[J]. 心肺血管病杂志, 2021, 40(9): 940-944, 950. doi: 10.3969/j.issn.1007-5062.2021.09.012
[10] Baumgartner H, Falk V, Bax JJ, et al. 2017 ESC/EACTS Guidelines for the management of valvular heart disease[J]. Eur Heart J, 2017, 38(36): 2739-2791. doi: 10.1093/eurheartj/ehx391
[11] Knuf KM, Maani CV, Cummings AK. Clinical agreement in the American Society of Anesthesiologists physical status classification[J]. Perioper Med(Lond), 2018, 7(1): 14. doi: 10.1186/s13741-018-0094-7
[12] 中华医学会重症医学分会. 急性肺损伤/急性呼吸窘迫综合征诊断和治疗指南(2006)[J]. 中华急诊医学杂志, 2007, 16(4): 343-349. doi: 10.3760/j.issn:1671-0282.2007.04.002
[13] Bai SJ, Zeng B, Zhang L, et al. Autologous Platelet-Rich Plasmapheresis in Cardiovascular Surgery: A Narrative Review[J]. J Cardiothorac Vasc Anesth, 2020, 34(6): 1614-1621.
[14] 王娜, 曾思思, 李佳蓓, 等. 体外循环对血小板数量和功能的影响及机制[J]. 中国体外循环杂志, 2022, 20(1): 53-58.
[15] Tong JQ, Cao L, Liu LW, et al. Impact of autologous platelet rich plasma use on postoperative acute kidney injury in type A acute aortic dissection repair: a retrospective cohort analysis[J]. J Cardiothorac Surg, 2021, 16(1): 9.
[16] Duan L, Wang E, Hu GH, et al. Preoperative autologous platelet pheresis reduces allogeneic platelet use and improves the postoperative PaO2/FiO2ratio in complex aortic surgery: a retrospective analysis[J]. Interact Cardiovasc Thorac Surg, 2020, 31(6): 820-826.
[17] 李正业, 王浩, 史玮, 等. 自体血小板分离回输技术对于不同血小板水平的主动脉夹层患者成分血输注量的影响研究[J]. 临床输血与检验, 2022, 24(2): 207-211. https://www.cnki.com.cn/Article/CJFDTOTAL-LSXY202202014.htm
[18] 雷迪斯, 曾琳玲, 巫红梅, 等. 术前自体血小板分离对复杂成人先天性心脏病手术的血液保护效果[J]. 岭南心血管病杂志, 2020, 26(3): 292-296. https://www.cnki.com.cn/Article/CJFDTOTAL-LXGB202003009.htm
[19] 胡燕, 严顺东, 吴雅娟, 等. 低剂量血小板预防性输注分析[J]. 临床血液学杂志, 2022, 35(10): 720-723. https://lcxy.whuhzzs.com/article/doi/10.13201/j.issn.1004-2806.2022.10.006
[20] Karlström C, Gryfelt G, Sc-hmied L, et al. Platelet transfusion improves clot formation and platelet function in severely thrombocytopenic haematology patients[J]. Br J Haematol, 2022, 196(1): 224-233.
[21] 翟晴, 田阿勇. 富血小板血浆分离应用于体外循环心脏手术的研究进展[J]. 中国医科大学学报, 2019, 48(2): 180-183.
[22] Shams HC, Singh S, Hesse C, et al. Effects of fibrinogen and platelet transfusion on coagulation and platelet function in bleeding cardiac surgery patients[J]. Acta Anaesthesiol Scand, 2019, 63(4): 475-482.
[23] Xin Y, Peng J, Hong YY, et al. Advances in research on the effects of platelet activation in acute lung injury(Review)[J]. Biomed Rep, 2022, 16(3): 17.
[24] 朱轶, 陈旭锋, 张劲松, 等. 血小板输注量对动脉-静脉体外膜肺氧合患者预后的影响: 一项连续三年的回顾性研究[J]. 中华急诊医学杂志, 2021, 30(10): 1177-1181.
[25] 何琛, 裴馨, 赵丽云, 等. 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[J]. 中国医药, 2019, 14(4): 517-521. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGYG201904011.htm
-
图(1)
表(1)
计量
- 文章访问数: 462
- PDF下载数: 181
- 施引文献: 0