Hiramatsu Takeshi, Okamura Tohru, Imai Yasuharu, Kurosawa Hiromi, Aoki Mitsuru, Shin'oka Toshiharu, Takanashi Yoshinori
Department of Cardiovascular Surgery, Tokyo Women's Medical University, Heart Institute of Japan.
Ann Thorac Surg. 2002 Apr;73(4):1282-5. doi: 10.1016/s0003-4975(01)03590-1.
Plasma pheresis and reinfusion of platelet-rich plasma has not been shown to reduce blood loss in cardiac patients. Recently, freshly prepared autologous platelet concentrates (PC) can be made from patient's blood and has a higher concentration than conventional platelet rich plasma. In this study, the effects of autologous PC reinfusion were examined after open heart surgery in patients with congenital heart disease.
Eight patients with noncyanotic congenital heart disease, who underwent open heart surgery and reinfusion of autologous PC, were classified as the PC group. Eight other patients with noncyanotic congenital heart disease, who underwent only open heart surgery, were defined as the control group. Ages ranged from 2 to 24 years and were not significantly different between the two groups (9.3 +/- 5.1 years in the PC group and 12.6 +/- 7.9 years in the control group, p = 0.33). In the PC group, blood was collected from the femoral vein through a 6F catheter introducer; 9 to 20 U (13.0 +/- 5.4 U, 0.42 +/- 0.22 U/kg) of autologous PC were prepared and were reinfused after protamine administration. The time course of platelet counts was examined until postoperative day 7. Aggregation responses to adenosine diphosphate; (4 micromol/L and 8 micromol/L), collagen (1 micromol/L and 5 micromol/L), and epinephrine (5 micromol/L and 10 micromol/L) were evaluated after induction of anesthesia (individual references), after protamine administration, at the end of the operation; these responses were shown as recovery ratios.
Blood loss during surgery in the PC group was significantly less than in the control group (4.8 +/- 3.0 mL/kg versus 7.8 +/- 1.7 mL/kg, p = 0.044). Similarly blood loss on postoperative day 1 in the PC group was significantly less than in the control group (3.6 +/- 1.2 mL/kg versus 7.2 +/- 3.1 mL/kg, p = 0.013). The platelet counts in the PC group were larger than those in the control group until postoperative day 5, after reinfusion of prepared autologous PC. The recovery ratios of the aggregation responses to adenosine diphosphate, collagen, and epinephrine after protamine administration were not significantly different between the two groups. However, recovery in the PC group after reinfusion of the prepared autologous PC was greater than in the control group.
Reinfusion of the freshly prepared autologous PC was followed by good aggregation responses and low blood loss in patients with noncyanotic congenital heart disease after open heart surgery. This procedure may be useful in pediatric open heart surgery without blood transfusion or with little administration of homologous blood products.
血浆置换和富血小板血浆回输尚未被证明可减少心脏手术患者的失血。最近，可从患者血液中制备新鲜的自体血小板浓缩物（PC），其浓度高于传统的富血小板血浆。在本研究中，对先天性心脏病患者心脏直视手术后自体PC回输的效果进行了检查。
8例非紫绀型先天性心脏病患者接受了心脏直视手术并回输了自体PC，被归为PC组。另外8例非紫绀型先天性心脏病患者仅接受了心脏直视手术，被定义为对照组。年龄范围为2至24岁，两组之间无显著差异（PC组为9.3±5.1岁，对照组为12.6±7.9岁，p = 0.33）。在PC组中，通过6F导管导入器从股静脉采集血液；制备9至20 U（13.0±5.4 U，0.42±0.22 U/kg）的自体PC，并在给予鱼精蛋白后回输。检查血小板计数的时间进程直至术后第7天。评估麻醉诱导后（个体参考值）、给予鱼精蛋白后、手术结束时对二磷酸腺苷（4 μmol/L和8 μmol/L）、胶原（1 μmol/L和5 μmol/L）以及肾上腺素（5 μmol/L和10 μmol/L）的聚集反应；这些反应以恢复率表示。
PC组手术期间的失血量显著少于对照组（4.8±3.0 mL/kg对7.8±1.7 mL/kg，p = 0.044）。同样，PC组术后第1天的失血量也显著少于对照组（3.6±1.2 mL/kg对7.2±3.1 mL/kg，p = 0.013）。在回输制备好的自体PC后，PC组的血小板计数在术后第5天之前均高于对照组。给予鱼精蛋白后，两组对二磷酸腺苷、胶原和肾上腺素的聚集反应恢复率无显著差异。然而，PC组在回输制备好的自体PC后的恢复情况优于对照组。
对于非紫绀型先天性心脏病患者，心脏直视手术后回输新鲜制备的自体PC后，聚集反应良好且失血量少。该方法可能在小儿心脏直视手术中不输血或少量输注同源血制品时有用。
