Shore-Lesserson L, Reich D L, DePerio M, Silvay G
Department of Anesthesiology, Mount Sinai Hospital, New York, New York 10029, USA.
Anesth Analg. 1995 Aug;81(2):229-35. doi: 10.1097/00000539-199508000-00004.
Preoperative platelet-rich plasmapheresis has been suggested as a means of reducing homologous blood transfusions in cardiac surgical patients. The current study evaluated this technique in patients undergoing repeat cardiac operations. Fifty-two patients undergoing repeat myocardial revascularization and/or valve replacement were evaluated in a prospective randomized controlled study design. Autologous platelet-rich plasma (PRP) was harvested after the induction of anesthesia in the experimental group. After reversal of heparin, each patient received his or her autologous plasma. Patients in the control group did not have plasmapheresis and received standard transfusion therapy if coagulation variables were abnormal and a coagulopathy was clinically evident. Routine coagulation tests, thromboelastography (TEG), perioperative bleeding, and transfusion requirements were compared in the two groups. Forty-four patients completed the study. A significantly larger volume of packed red blood cells (PRBCs) was transfused in the PRP group than in the control group (P = 0.03). Platelet and fresh frozen plasma (FFP) transfusions did not differ between the two groups. Mediastinal tube drainage did not differ between the two groups. During PRP infusion, 60% of the patients required treatment for moderate hypotension (mean arterial pressure [MAP] < 60 mm Hg). Only 16% of control patients required treatment for hypotension during the comparable time period (P < 0.05). No patient who completed the study returned to the operating room for postoperative bleeding. These data suggest that PRP did not reduce postbypass bleeding or transfusion requirements in repeat cardiac surgical patients. Moreover, the incidence of hypotension during PRP reinfusion introduces a potential risk to the procedure in the absence of any obvious benefit.
术前富血小板血浆置换术已被提议作为减少心脏手术患者同种异体输血的一种方法。本研究对接受再次心脏手术的患者评估了该技术。在一项前瞻性随机对照研究设计中，对52例接受再次心肌血运重建和/或瓣膜置换的患者进行了评估。在实验组，麻醉诱导后采集自体富血小板血浆（PRP）。肝素逆转后，每位患者接受其自体血浆。对照组患者未进行血浆置换，若凝血指标异常且临床上有明显凝血功能障碍，则接受标准输血治疗。比较两组的常规凝血试验、血栓弹力图（TEG）、围手术期出血情况及输血需求。44例患者完成了研究。PRP组输注的浓缩红细胞（PRBCs）量明显多于对照组（P = 0.03）。两组之间的血小板和新鲜冰冻血浆（FFP）输注情况无差异。两组的纵隔引流管引流量无差异。在输注PRP期间，60%的患者需要治疗中度低血压（平均动脉压[MAP]<60 mmHg）。在可比时间段内，仅16%的对照组患者需要治疗低血压（P<0.05）。完成研究的患者中没有因术后出血返回手术室的。这些数据表明，PRP并不能减少再次心脏手术患者体外循环后的出血或输血需求。此外，在没有任何明显益处的情况下，PRP再输注期间低血压的发生率给该手术带来了潜在风险。
