自体血小板分离联合术中自体血回输对骨科手术患者凝血功能的影响作用

目的观察术前自体血小板分离联合术中自体血回输对骨科手术患者凝血功能的影响作用。方法60例骨科择期手术患者（预计出血量〉1000ml,ASAⅠ～Ⅱ级）,随机分为3组,每组20例患者。Ⅰ组采用术前自体血小板分离联合术中自体血回输,Ⅱ组采用单纯术中自体血回输,Ⅲ组不进行任何血液保护措施。各组分别于麻醉前、血小板分离后10min、保存的血小板或自体血回输前10min、回输后10min、术后24h、术后48h检测相应时点的血红蛋白水平、凝血功能、血小板水平和聚集功能、术中术后出血量及异体输血情况。结果三组的一般资料、术中出血量、术中术后的血红蛋白水平比较未见明显差异。与Ⅰ组相比,Ⅱ、Ⅲ组术后24h和术后48h的血小板水平和聚集功能明显降低（P〈0．05）,术后出血量及异体输血率则明显增高（P〈0．01）。结论术前自体血小板分离联合术中自体血回输可明显改善骨科手术患者的凝血功能,并有效降低术后出血量和异体血的输注。

Effectiveness of preoperative autologous plateletpheresis combined with intraoperative autotransfusion on the blood coagulation in orthopaedic patients

OBJECTIVE: To investigate the effectiveness of preoperative plateletpheresis combined with intraoperative autotransfusion on the blood coagulation of orthopaedic patients. METHODS: Sixty patients (ASA I-II) undergoing selective orthopaedic surgery were randomized into three groups (n = 20), that is, preoperative plateletpheresis combined with intraoperative autotransfusion for group I, intraoperative autotransfusion for group II, and group III without any managements of blood conservation. Coagulation parameters (prothrombin time, partial thromboplastin time, fibrinogen), hemoglobin and hematocrit values, platelet counts and aggregability were evaluated before the anaestheria, 10 minutes after plateletpheresis, 10 minutes before the infusion of platelet rich plasma or autologous blood, 10 minutes after infusion, 24 and 48 hours postoperation. Intra- and postoperation blood loss and homologous blood transfusion requirements were also recorded. RESULTS: Among three groups, there were no differences in intraoperation blood loss, perioperation haemoglobin level (Hb and Hct). As compared with group I, significant lower level of platelet counts and aggregability were observed in group II and III at the time of 24 and 48 hours after operation (P < 0.05), while postoperation blood loss and homologous blood-transfusion requirements increased at the same period (P < 0.01). CONCLUSIONS: Preoperative plateletpheresis combined with intraoperative autotransfusion can ameliorate the blood coagulation in orthopaedic patients, and it is an effective way to decrease blood loss and homologous blood-transfusions requirements.