| Objective:As a new technique of blood protection,autologous blood separation of platelet-rich plasma is gradually applied in cardiac aortic surgery.At present,it is mostly believed that it has a certain effect on reducing postoperative blood loss,reducing postoperative cryoprecipitate and red blood cell transfusion.On the other hand,by measuring IL-6,IL-8,IL-10,TNF-α and other inflammatory factors in plasma and tissues,systemic inflammation during and after cardiac aortic surgery can be assessed to a certain extent.Autologous blood separation of platelet-rich plasma is usually performed before heparinization,but the separation of platelet-rich plasma with the surgical incision as the node has not been mentioned in research.This study intends to investigate the subjects undergoing cardiac aortic surgery under cardiopulmonary bypass to collect platelet-rich plasma at different time points(from induction of anesthesia to before the surgical incision or from after the surgical incision to before heparinization)by measuring both the inflammatory factors(IL-6,IL-8,IL-10,TNF-α)and blood gas analysis results in human body and in vitro,so as to find the best time to collect platelet-rich plasma under cardiac aortic surgery and provide a basis for blood protection strategies.Methods: This study was a prospective,cross-controlled clinical trial.According to the selection criteria and exclusion criteria,40 subjects undergoing cardiac aortic surgery were randomly divided into two groups.Group A was collecting platelet-rich plasma from induction of anesthesia to at the start of the surgical incision,and group B was collecting platelet-rich plasma from at the start of the surgical incision to at the start of heparinization.The main research objectives of this study was to detect the concentration of inflammatory factors(IL-6,IL-8,IL-10,TNF-α)at T1,TPRP,T2,T3,T4,Ta,Tb,Tc,Td.(T1(immediately after successful central venipuncture-under anesthesia at this time-baseline),TPRP(blood separation ended),T2(5 minutes later after median split sternum),T3(10 minutes later after platelet).Secondary research objectives included general data on subjects(age,sex,weight,height,preoperative white blood cell count,preoperative red blood cell count,preoperative hemoglobin levels and count,duration of aortic cross clamp,duration of cardiopulmonary bypass,duration of surgery,minimum nasopharyngeal temperature,total heparin dose,total protamine dose).And the relevant results of the platelet-rich plasma collected by autologous centrifugation in group A and group B(the volume of whole blood collected by the autologous centrifugation,the volume of platelet-rich plasma collected,and the volume of concentrated red blood cells obtained by separation)were included.The results of blood gas analysis(PH value,blood potassium concentration,blood calcium concentration,blood lactate value,blood sugar value,etc.)in the above-mentioned different periods and the postoperative drainage and perioperative allogeneic blood infusion were also included.Results: A total of 40 patients met the inclusion criteria(20 cases in group A vs 20 cases in group B),of which 11 patients were excluded from the sample,so the total number of subjects included in the final analysis was 29 cases(13 cases in group A vs16 cases in group B).The main research objective was the concentration of inflammatory factors in the human body: the concentration of IL-6 in the human body at each time point in group A was not significantly different from that in group B.(IL-6: Group A VS Group B T1P=0.607,T3 P=0.283,T4 P=0.092,all P values were>0.05).The concentration of IL-8in the human body at each time point in group A was not significantly different from that in group B.(IL-8: Group A VS Group B T1 P=0.691,T3 P=0.159,T4 P=0.190,all P values were>0.05)The concentration of IL-10 in the human body at each time point in group A was not significantly different from that in group B.(IL-10: Group A VS Group B T1 P=0.607,T3 P=0.283,T4 P=0.092,all P values were>0.05)The concentration of TNF-α at T4 in the human body of the group A is lower than that of the group B((P=0.029<0.05)and the concentration of TNF-α in the human body at all other time points in group A was not significantly different from that in group B.(TNF-α: Group A VS Group B T1 P=0.442,T3 P=0.888,T4 P=0.029,all P values were>0.05)The main research objective was also the concentration of inflammatory factors in platelet-rich plasma collected: there was no significant statistical difference in IL-6 in platelet-rich plasma collected at each time point in group A and group B.(IL-6: Group A VS Group B Ta P=0.450,Tb P=0.596,Tc P=0.591,all P values were>0.05)The concentration of IL-8 in platelet-rich plasma collected at each time point in group A was not significantly different from that in group B.(IL-8: Group A VS Group B Ta P=0.109,Tb P=0.072,Tc P=0.207,Td P=0.257,all P values were>0.05)There was no significant statistical difference in IL-10 in platelet-rich plasma collected at each time point in group A and group B.(IL-10: Group A VS Group B Ta P=0.109,Tb P=0.072,Tc P=0.207,all P values were>0.05)The concentration of TNF-α in platelet-rich plasma collected at each time point in group A was not significantly different from that in group B.(TNF-α: Group A VS Group B Ta P=0.944,Tb P=0.973,Tc P=0.987,Td P=0.885,all P values were>0.05)Secondary research objectives: The general data of the group A and group B were similar.The total volume of whole blood collected of all subjects was 833.5 ±94.1ml,the volume of platelet-rich plasma collected was 595.4 ± 109.5ml,and the volume of concentrated red blood cells obtained was 281.8 ±18.8ml.The results of blood gas and electrolyte analysis in the human body: there was no significant statistical difference in the Hb concentration in the human body between the group A and group B at each time point.(Group A vs Group B T1 P=0.747,T3 P=0.500,T4 P=0.192,all P values were>0.05)There was no significant statistical difference in the Hct concentration in human body at each time point between the group A and group B.(Group A vs Group B T1 P=0.741,T3 P=0.487,T4 P=0.256,all P values were>0.05)There was no significant statistical difference in the concentration of lactic acid in human body at each time point between the group A and group B.(Group A vs Group B T1 P=0.658,T3 P=0.330,T4 P=0.907,all P values>0.05)The analysis of electrolyte concentration in platelet-rich plasma: there was no significant difference in the level of lactic acid in platelet-rich plasma collected at each time point in group A.(Group A vs Group B Ta P=0.413,Tb P=0.525,Tc P=0.479,Td P=0.311,all P values were>0.05)There was no significant difference in the p H level in platelet-rich plasma collected at each time point in group A.(Group A vs.Group B Ta P=0.183,Tb P=0.222,Tc P=0.164,Td P=0.885,all P values were>0.05)The drainage volume of group A was 808.5±318.2ml at 24 hours after surgery,and that of group B was 825.6±331.3 ml(P value was >0.05).The intraoperative infusion of red blood cells in group A was 2.3±2.9 U,and that in group B was 1.3±1.9 U(P value was >0.05).Conclusion: There was no significant difference in inflammatory factors(IL-6,IL-8,IL-10,TNF-α)in human body and in vitro between collected platelet-rich plasma before the surgical incision and platelet-rich plasma after the surgical incision.In other words,from the point of view of inflammation,the collection of platelet-rich plasma can be completed before systemic heparinization in cardiac aortic surgery.As a result,it can avoid affecting the operation process and increasing the time and cost of anesthesia for platelet-rich plasma collection. |
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