【摘要】 目的 探讨利用连续性血细胞分离机采集自体富血小板血浆(Autologous Platelet-Rich Plasma, aPRP)对A型主动脉夹层患者的血液保护作用及对预后的影响。方法 回顾性收集本院2020—2023年期间接受急诊主动脉置换术的急性A型主动脉夹层患者的临床资料。根据术前是否采集aPRP用于术后回输分为aPRP组(n=32)和对照组(n=35)。记录aPRP的采集量及其中血小板的浓度。比较两组住院期间各种异体血液、血液制品输注量及血费。比较两组术中出血量、围术期实验室指标变化、术后24 h引流量、ICU滞留时间、机械通气时间、住院天数及死亡率。结果 aPRP中血小板浓度为(491.5±85.4)×10~9/L,占患者血小板总数的(24.1±9.6)%,aPRP采集量占患者血浆容量的(23.0±6.3)%。与对照组相比较，aPRP组异体红细胞、血浆和血小板输注量明显减少(P<0.05),住院期间总血费明显降低(P<0.05),术后凝血功能指标(APTT、PT、INR、TEG)明显改善(P<0.05),术后血小板计数明显增加(P<0.05)。但两组术后凝血酶原复合物和纤蛋白原用量差异无统计学意义。术后24 h引流量、术后24 h拔管率、ICU滞留时间、机械通气时间、住院天数差异无统计学意义。两组并发症发生率及死亡率差异无统计学意义。结论 aPRP减少了A型主动脉夹层患者围术期异体血液输注，改善了患者凝血功能，同时减少了血费，是一种有效、安全的血液保护策略。更多还原

【Abstract】 Objective To investigate the effects of autologous platelet-rich plasma(aPRP) collected using a continuous blood cell separator on blood conservation and prognosis in patients with type A aortic dissection. Methods The clinical data of patients who underwent emergency aortic replacement for acute type A aortic dissection at our hospital from January 2020 to December 2023 were respectively analyzed. Patients were divided into two groups based on whether they received aPRP collection before surgery for subsequent reinfusion: the aPRP group(n=32) and the control group(n=35). The volume of aPRP collected and the platelet concentration in the aPRP were recorded. The volumes of allogeneic blood and blood products transfused, and the associated costs during hospitalization were compared between two groups. Intraoperative blood loss, perioperative laboratory parameter changes, 24-hour postoperative drainage volume, duration of ICU stay and mechanical ventilation, length of hospital stay, and mortality rate of the two groups were also compared. Results The platelet concentration in aPRP was(491.5±85.4)×10~9/L, accounting for(24.1±9.6)% of the patient′s total platelet count. The volume of aPRP collected accounted for(23.0±6.3)% of the patient’s total plasma volume. Compared with the control group, the aPRP group demonstrated significantly reduced transfusion volumes of allogeneic red blood cells, plasma, and platelets(P<0.05), along with significantly lower blood-related costs during hospitalization(P<0.05). Postoperative coagulation parameters(APTT, PT, INR, and TEG) were significantly improved(P<0.05), and platelet counts were markedly increased(P<0.05) in aPRP group as compared with the control group. No statistically significant differences were observed in postoperative use of prothrombin complex concentrate and fibrinogen between the two groups. Similarly, there were no significant differences in postoperative 24-hour drainage volume, 24-hour extubation rate, ICU length of stay, duration of mechanical ventilation, or total hospital length of stay. The incidence of complications and mortality did not differ significantly between the two groups. Conclusion The administration of aPRP significantly reduces the requirement for perioperative allogeneic blood transfusion in patients undergoing surgery for type A aortic dissection. Furthermore, it enhances coagulation function and reduces associated transfusion costs, thereby establishing itself as an effective and safe strategy for blood conservation.更多还原