BACKGROUND:Blood conservation remains an important element for patients undergoing cardiac operations with cardiopulmonary bypass. Preoperative platelet-rich plasma (PRP) harvest is an autologous blood conservation method. The efficacy of preoperative PRP harvest and post-cardiopulmonary bypass reinfusion on postoperative bleeding and need for postoperative blood transfusion was evaluated in patients undergoing redo coronary artery bypass grafting in a prospective, randomized manner.
METHODS:All adult patients admitted for redo coronary artery bypass grafting entered into the study. The PRP harvest aim was 20% or more of the total estimated circulating platelets. Immediately preoperatively three sequestration cycles were performed. The PRP was reinfused after weaning from cardiopulmonary bypass. One hundred seven parameters/patient were recorded. There were 20 patients in the RPR group and 20 controls (without PRP harvest).
RESULTS:Patient characteristics, operative data, and preoperative hematologic parameters did not differ between the groups. In the PRP group, the mean platelet count in the PRP was 864 +/- 139 x 10(3)/microL, and the platelet yield was 27% +/- 5% (range, 20% to 37%). The average total chest tube blood loss was 423 mL (PRP) compared with 1,462 mL (controls; p < 0.001). Fourteen patients in the control group required blood transfusions postoperatively compared with only 1 patient in the PRP group (p < 0.001). Postoperative fluid requirements were also significantly greater in the control group (p < 0.001). Postextubation gas exchange was significantly better in the PRP group compared with controls (p < 0.01). Postoperative ventilation time and intensive care stay were significantly shorter in patients in the PRP group.
CONCLUSIONS:A preoperative PRP harvest of 20% or more of the total platelets and reinfusion of the PRP after cardiopulmonary bypass resulted in significantly less postoperative blood loss and decreased fluid and blood transfusion requirements compared with controls. Postextubation gas exchange, ventilation time, and time required in the intensive care unit were also better, and the method was found cost-effective.
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【Plateletpheresis before redo CABG diminishes excessive blood transfusion.].
【重做CABG之前的血小板减少减少了过多的输血。】
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DOI：10.1016/0003-4975(96)00751-5文章类型：杂志文章
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背景：血液保持仍然是接受心脏体外循环心脏手术患者的重要因素。术前富血小板血浆（PRP）收获是一种自体血液保存方法。以前瞻性，随机方式评估了接受重做冠状动脉搭桥术的患者的术前PRP收集和体外循环后再输注对术后出血和术后输血的需要的疗效。
方法：所有接受重做冠状动脉旁路移植术的成年患者均进入研究。 PRP的收获目标是估计的总循环血小板的20％或更多。术前立即进行了三个隔离周期。断奶后从心肺转流术中重新注入PRP。记录了一百七十七个参数/患者。 RPR组有20例患者，而对照组则有20例（未收获PRP）。
结果：两组患者的特征，手术数据和术前血液学参数无差异。在PRP组中，PRP中的平均血小板计数为864 /-139 x 10（3）/ microL，血小板产率为27％/-5％（范围为20％至37％）。平均总胸管失血量为423 mL（PRP），而同期为1,462 mL（对照； p <0.001）。对照组中有14名患者术后需要输血，而PRP组中只有1名患者（p <0.001）。对照组的术后液体需求量也显着更高（p <0.001）。与对照组相比，PRP组拔管后的气体交换明显更好（p <0.01）。 PRP组患者的术后通气时间和重症监护时间明显缩短。
结论：与对照组相比，术前PRP采集占总血小板的20％或更多，并在体外循环后再输注PRP导致术后失血量明显减少，输液量和输血量减少。拔管后的气体交换，换气时间和重症监护室所需的时间也更好，该方法具有成本效益。
方法：所有接受重做冠状动脉旁路移植术的成年患者均进入研究。 PRP的收获目标是估计的总循环血小板的20％或更多。术前立即进行了三个隔离周期。断奶后从心肺转流术中重新注入PRP。记录了一百七十七个参数/患者。 RPR组有20例患者，而对照组则有20例（未收获PRP）。
结果：两组患者的特征，手术数据和术前血液学参数无差异。在PRP组中，PRP中的平均血小板计数为864 /-139 x 10（3）/ microL，血小板产率为27％/-5％（范围为20％至37％）。平均总胸管失血量为423 mL（PRP），而同期为1,462 mL（对照； p <0.001）。对照组中有14名患者术后需要输血，而PRP组中只有1名患者（p <0.001）。对照组的术后液体需求量也显着更高（p <0.001）。与对照组相比，PRP组拔管后的气体交换明显更好（p <0.01）。 PRP组患者的术后通气时间和重症监护时间明显缩短。
结论：与对照组相比，术前PRP采集占总血小板的20％或更多，并在体外循环后再输注PRP导致术后失血量明显减少，输液量和输血量减少。拔管后的气体交换，换气时间和重症监护室所需的时间也更好，该方法具有成本效益。
