【摘要】 目的探讨富血小板血浆(platelet rich plasma,PRP)分离回输技术在双侧全髋关节置换手术中的节血效果及对凝血功能的影响。方法选取北京积水潭医院行双侧全髋关节置换术的患者60例(年龄>18岁,ASAⅠ~Ⅱ级),采用随机数字表法随机分为PRP组(n=30,实施术前血小板分离并术中回输)和对照组(n=30,不实施血小板分离)。记录输液量、失血量、自体血回收量、异体血输注量、尿量、术后引流量(术后6小时及24小时)及围术期凝血功能检查结果(包括D-二聚体、纤维蛋白原含量、凝血酶原时间、国际标准化比值、活化凝血酶原时间、血小板含量)、血红蛋白含量及血气分析结果等,同时应用血栓弹力图(thrombelastogram,TEG)分析患者围术期凝血功能的变化。结果两组患者手术时间、输液量、失血量及自体血回收量等差异均无显著性(P>0.05),异体血输注量明显少于对照组(P=0.024)。PRP组纤维蛋白原含量明显高于对照组(P=0.008)。TEG检查结果显示PRP组活化凝血时间及凝固时间明显低于对照组(P=0.038、0.002);PRP组血块形成最大幅度明显高于对照组(P=0.002)。两组患者血气分析结果差异无显著性(P>0.05)。结论富血小板血浆分离回输技术可以减少双侧全髋关节置换围术期异体血输注量,且对凝血功能有积极保护作用。更多还原

【Abstract】 Objective To explore the blood-saving effect of platelet-rich plasma(PRP) sequestration and retransfusion in bilateral hip replacement surgery as well as its influence on coagulation function. Method 60 cases(>18 years old, ASAⅠ~Ⅱ) receiving bilateral hip replacement surgery were enrolled in our study. All patients were divided into two groups randomly: the platelet-rich plasma sequestration and retransfusion group(PRP group, n=30, the platelet-rich plasma sequestration and retransfusion was performed), and the control group(n=30, no platelet-rich plasma sequestration and retransfusion). The transfusion volume, blood loss, autologous blood transfusion, allogeneic blood transfusion, urine volume, postoperative drainage(6 h and 24 h after operation) and perioperative coagulation function test(including D-Dimer, FIB, PT, INR, APTT, PLT), Hb concentration and blood gas analysis results were recorded. The coagulation function was also analyzed with TEG. Result The operative duration, transfusion volume, blood loss and autologous blood transfusion of two groups were comparative. The allogeneic blood transfusion of group PRP was significantly less than the control group(P=0.024). The FIB of group PRP was obviously higher than control group(P=0.008). The ACT and coagulation time(K) of PRP group were markedly lower than the control group(P=0.038, 0.002), while the maximum amplitude(MA) of the control group was significantly lower than the PRP group(P=0.002). As to the blood gas analysis results, no markedly differences were detected between two groups. Conclusion PRP can reduce the allogeneic blood requirement in bilateral total hip replacement surgery and exerts a positive protective effect on coagulation function.更多还原