Tobe C E, Vocelka C, Sepulvada R, Gillis B, Nessly M, Verrier E D, Hofer B O
Division of Cardiothoracic Surgery, University of Washington Medical Center, Seattle 98195.
J Thorac Cardiovasc Surg. 1993 Jun;105(6):1007-13; discussion 1013-4.
Prior nonblinded studies have suggested dramatic hemostatic effects and decreased plasma after cardiopulmonary bypass. Platelet rich plasma (8 to 10 ml/kg total body weight) was obtained (Haemonetics Plasma Saver; Haemonetics Corp., Natick, Mass.) from 51 patients undergoing primary coronary artery bypass grafting before heparinization. After double-blinded randomization, the platelet rich plasma was reinfused immediately in the control group or after heparin reversal in the treatment group. Homologous blood product usage, blood loss, and the surgeon's intraoperative subjective assessment of coagulation were evaluated. Additionally, thromboelastography, prothrombin time, partial thromboplastin time, activated clotting time, fibrinogen, platelet counts, and hematocrit values were evaluated before the operation, after heparin reversal, after infusion of platelet rich plasma or control solution, and 2 hours after infusion. The surgeon's subjective assessment of coagulation was not different between control and treatment groups (p = 0.78). According to specific predetermined transfusion guidelines, no statistically significant differences were found in the use of whole blood (p = 0.07), packed red blood cells (p = 0.62), platelets (p = 0.11), total units of blood products (p = 0.45), or in the percentage of patients receiving transfusions (control group 70%, treatment group 71%, p = 0.97). Cumulative amount of blood shed through the chest tube was not significantly different between the groups at any interval but tended toward significance at 4, 6, and 12 hours (p = 0.09, 0.07, and 0.09). The prothrombin time immediately after reinfusion of platelet rich plasma was significantly lower in the treatment group (p = 0.03), but all other laboratory studies were similar at each time interval. Infusion of platelet rich plasma after cardiopulmonary bypass in patients having uncomplicated primary coronary artery bypass grafting has minimal effects on the surgeon's assessment of coagulation, total transfusion requirements, mediastinal drainage, and laboratory studies of coagulation.
先前的非盲法研究表明，体外循环后有显著的止血效果且血浆量减少。从51例接受初次冠状动脉搭桥术的患者在肝素化前获取富血小板血浆（总量为8至10 ml/kg体重）（Haemonetics血浆采集器；Haemonetics公司，马萨诸塞州纳蒂克）。经过双盲随机分组后，富血小板血浆在对照组中立即回输，在治疗组中则在肝素中和后回输。评估了同种异体血制品的使用情况、失血量以及外科医生对凝血的术中主观评估。此外，在手术前、肝素中和后、富血小板血浆或对照溶液输注后以及输注后2小时，评估了血栓弹力图、凝血酶原时间、部分凝血活酶时间、活化凝血时间、纤维蛋白原、血小板计数和血细胞比容值。对照组和治疗组外科医生对凝血的主观评估没有差异（p = 0.78）。根据特定的预定输血指南，在全血使用（p = 0.07）、浓缩红细胞使用（p = 0.62）、血小板使用（p = 0.11）、血制品总单位数（p = 0.45）或接受输血患者的百分比（对照组70%，治疗组71%，p = 0.97）方面，未发现统计学上的显著差异。在任何时间段，两组通过胸管流出的累计出血量均无显著差异，但在4小时、6小时和12小时时有显著差异的趋势（p = 0.09、0.07和0.09）。富血小板血浆回输后，治疗组的凝血酶原时间立即显著降低（p = 0.03），但在每个时间间隔的所有其他实验室研究结果相似。在进行无并发症的初次冠状动脉搭桥术的患者中，体外循环后输注富血小板血浆对外科医生对凝血的评估、总输血需求、纵隔引流以及凝血实验室研究的影响极小。
