Department of Anesthesiology, the First Affiliated Hospital of China Medical University (CMU), Shenyang, Liaoning, China.
Department of Gerontology and Geriatrics, the First Affiliated Hospital of China Medical University (CMU), Shenyang, Liaoning, China.
J Clin Anesth. 2019 Sep;56:88-97. doi: 10.1016/j.jclinane.2019.01.018. Epub 2019 Jan 29.
This study aimed to explore the effects of platelet-rich plasmapheresis (PRP) on the amount of postoperative blood loss and the requirements for allogeneic fresh frozen plasma (FFP) and red blood cell (RBC) transfusions during cardiovascular surgery.
A literature search of 7 online databases was conducted. Randomized control trials (RCT) comparing intraoperative PRP or appropriate control groups were considered suitable for this current study.
Fifteen RCTs enrolling a total of 1002 patients, including 501 patients who received PRP and 501 control patients. Meta-analysis of the data from these trials showed that PRP reduced the total volume of postoperative blood loss (standardized mean difference [SMD], -0.74; 95% confidence interval [CI], -1.18 to -0.31; P < 0.05), reduced postoperative fresh frozen plasma (FFP) transfusion (SMD, -0.38; 95%CI, -0.69 to -0.08; P < 0.05), reduced postoperative RBCs transfusion (SMD, -0.44; 95%CI, -0.77 to -0.10; P < 0.05), and reduced the proportion of patients receiving postoperative allogeneic RBC transfusions (relative risk [RR], 0.44; 95%CI, 0.21-0.91, P < 0.05) during cardiovascular surgery.
Conducting PRP before cardiopulmonary bypass (CPB) and transfusing autologous platelet-rich plasma (aPRP) after reversal of heparin could reduce postoperative blood loss, the requirements for blood products transfusion during cardiovascular surgery. A higher mean platelet count in aPRP may improve the final outcome. However, there was a high degree of undetermined heterogeneity among the analyzed trials, and larger and more precise RCTs are needed to confirm these conclusions.
本研究旨在探讨富血小板血浆离心（PRP）在体外循环心脏手术中对术后出血量、异体新鲜冷冻血浆（FFP）和红细胞（RBC）输注需求的影响。
对 7 个在线数据库进行文献检索。纳入比较术中 PRP 或适当对照组的随机对照试验（RCT）。
纳入 15 项 RCT 共 1002 例患者，其中 PRP 组 501 例，对照组 501 例。对这些试验数据的荟萃分析显示，PRP 减少了术后总失血量（标准化均数差 [SMD]，-0.74；95%置信区间 [CI]，-1.18 至 -0.31；P<0.05）、术后 FFP 输注（SMD，-0.38；95%CI，-0.69 至 -0.08；P<0.05）、术后 RBC 输注（SMD，-0.44；95%CI，-0.77 至 -0.10；P<0.05），并降低了术后接受异体 RBC 输注的患者比例（相对风险 [RR]，0.44；95%CI，0.21-0.91，P<0.05）。
在体外循环前进行 PRP 处理，在肝素逆转后输注自体富血小板血浆（aPRP），可减少心脏手术后的出血量和血液制品输注需求。aPRP 中的平均血小板计数较高可能改善最终结局。但是，分析试验中存在高度不确定的异质性，需要更大、更精确的 RCT 来证实这些结论。
