术前自体富血小板血浆置换对心脏瓣膜手术患者术后出血的影响。
Effect of preoperative autologous platelet-rich plasmapheresis on postoperative bleeding in patients undergoing heart valve surgery.
作者信息
Liu Manman, Liang Chao, Ying Meijing, Ortolani Fulvia, Wu Biling, Liu Jie, Yang Zhen, Xiong Wanxia, Ding Ming
机构信息
Department of Anesthesiology, Zhongshan Hospital (Xiamen), Fudan University, Xiamen, China.
Department of Anesthesiology, Zhongshan Hospital, Fudan University, Shanghai, China.
出版信息
J Thorac Dis. 2024 Jul 30;16(7):4584-4596. doi: 10.21037/jtd-24-794. Epub 2024 Jul 22.
BACKGROUND
Cardiovascular surgeries often require deep hypothermic circulatory arrest and cardiopulmonary bypass (CPB), which can disrupt blood clotting and lead to excessive bleeding. Traditional treatments involve transfusing blood and blood products, which can have adverse effects and place significant strain on the global blood supply. Research suggests that autologous platelet-rich plasmapheresis (aPRP) may reduce the need for transfusions by preserving blood components. However, the impact of aPRP on postoperative blood loss and clinical outcomes in cardiovascular surgery remains controversial. This study aimed to examine the effects of aPRP on postoperative blood loss and recovery in patients undergoing heart valve surgery.
METHODS
A total of 183 patients were divided into either aPRP or control groups. The aPRP group received aPRP before CPB, whereas the control group did not. The primary endpoint was postoperative bleeding between the groups. The secondary endpoints were postoperative bleeding risk factors and clinical outcome assessment. Logistic regression analysis with covariate adjustment was used to calculate these risk factors.
RESULTS
A total of 76 patients (41.5%) in the aPRP group and 107 patients (58.5%) in the control group were included in the analysis. No significant difference was found in the occurrence of postoperative bleeding [odds ratio (OR) =0.53, 95% confidence interval (CI): 0.28-1.00, P=0.05], and the aPRP group had fewer complications than the controls (OR =0.28, 95% CI: 0.10-0.68, P=0.009). However, after adjusting for the New York Heart Association (NYHA) classification, diabetes, arrhythmology, mean activated clotting time (ACT), CPB, bleeding, thoracotomy, and body mass index (BMI), there was a significant difference in postoperative bleeding (adjusted OR =0.47, 95% CI: 0.22-0.98, P=0.04) and complications (adjusted OR =0.23, 95% CI: 0.07-0.64, P=0.008) between the two groups.
CONCLUSIONS
Preoperative aPRP can improve postoperative outcomes and reduce complications in patients undergoing heart valve surgery.
背景
心血管手术通常需要深度低温循环停搏和体外循环（CPB），这可能会破坏血液凝固并导致过度出血。传统治疗方法包括输注血液和血液制品，这可能会产生不良影响，并给全球血液供应带来巨大压力。研究表明，自体富血小板血浆置换术（aPRP）可能通过保存血液成分来减少输血需求。然而，aPRP对心血管手术术后失血和临床结局的影响仍存在争议。本研究旨在探讨aPRP对心脏瓣膜手术患者术后失血和恢复的影响。
方法
总共183例患者被分为aPRP组或对照组。aPRP组在CPB前接受aPRP，而对照组未接受。主要终点是两组之间的术后出血情况。次要终点是术后出血危险因素和临床结局评估。采用协变量调整的逻辑回归分析来计算这些危险因素。
结果
分析纳入了aPRP组的76例患者（41.5%）和对照组的107例患者（58.5%）。术后出血发生率无显著差异[比值比（OR）=0.53，95%置信区间（CI）：0.28 - 1.00，P = 0.05]，且aPRP组的并发症比对照组少（OR = 0.28，95% CI：0.10 - 0.68，P = 0.009）。然而，在调整纽约心脏协会（NYHA）分级、糖尿病、心律失常、平均活化凝血时间（ACT）、CPB、出血、开胸手术和体重指数（BMI）后，两组之间术后出血（调整后的OR = 0.47，95% CI：0.22 - 0.98，P = 0.04）和并发症（调整后的OR = 0.23，95% CI：0.07 - 0.64，P = 0.008）存在显著差异。
结论
术前aPRP可改善心脏瓣膜手术患者的术后结局并减少并发症。
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