Effect Of Autologous Platelet Rich Plasma On Blood Conservation And Short Prognosis In Patients Undergoing Type A Aortic Dissection Surgery

Objective:To investigate the effect of autologous platelet rich plasma(aPRP)on blood conservation and short time prognosis in patients undergoing type A aortic dissection surgery.Methods:We retrospectively analyzed 115 patients who accepted Stanford type A aortic dissection surgery in Tianjin Chest Hospital during the period from January2016 to December 2018,in which 83 male and 32 female included,and age ranging from 21 to 81 years old,with BMI 16.7?41.9 kg/m~2,NYHA class II?III,ASA class III?IV.These patients divided into two groups:Autologous platelet separation and transfusion group(P group,n=55)and conventional blood management measures(C group,n=60).After anesthesia induction and intubation,all patients insert the three-lumen central venous catheter and the external sheath of the Swan-Ganz catheter into the right internal jugular vein in the two groups.In autologous platelet separation and transfusion group,autologous platelet collection and separation were carried out before the operation,platelet rich plasma was prepared,stored in a special blood storage bag with constant oscillation.All platelet rich plasma was immediately transfused back to the patients after protamine neutralization and heparin with no obvious surgical bleeding.The control group did not use aPRP,and the operation was started directly.Only the blood recovery instrument was used to recover blood during the operation and the rest blood after the machine was stopped were washed and recovered.The allogeneic blood was transfused to patients via peripheral venous infusion according to the situation in two groups.In the research we record preoperative and intraoperative related information of two group patients.The main indicators:perioperative circle patients transfused to allogeneic blood,postoperative mortality and incidence of perioperative adverse events(acute renal insufficiency required continuous renal replacement therapy,neurological complications,cardiac arrest or ventricular fibrillation,pulmonary infection or secondary thoracotomy for hemostasis).The secondary indicators:aortic cross-clamp time,hypothermic recursive engage time,In the operation bleeding,postoperative drainage volume,postoperative extubation time,ventilator-assisted mechanical ventilation time,ICU residence time and hospitalization expenses.All data was analyzed with SPSS 24.0statistical software.The measurement data and count were represented with numerical value and number of cases respectively.One-way analysis of variance,Paired-Samples T Test and the Chi-square test was used for comparison.Use Kaplan-Meier curve to compare the survival curves of two groups.Analyze the relevant factors of death and complications using univariate and multivariate Logistic regression analyses.P<0.05 was considered as statistically significant difference.Results:1.General data comparison:there are 115 patients data were statistically analyzed.There was no important difference entre the two groups in gender,age,height,weight and BMI(P>0.05),and no significant differences in previous medical history(smoking history,hypertension,hyperlipidemia,cerebrovascular accident,diabetes)between the two groups(P>0.05),shown in table 2.The main indicators:compared with the C group,the volume of allogeneic RBC[(0.9±2.0)unit VS(1.7±2.2)unit,P<0.05],allogeneic RBC infusion rate[(13/55,23.6%)VS(29/60,48.3%),P<0.05],volume of allogeneic plasma[(389.6±422.5)ml VS(499.3±341.3)ml,P<0.05],allogeneic plasma transfusion rate[(33/55,60.0%)VS(48/60,80.0%),P<0.05]significantly reduced.There was no significant difference in postoperative mortality and incidence of postoperative adverse events(P>0.05).3.The secondary indicators:compared with the control group,postoperative drainage volume in the experimental group was significantly reduced[(1893.7±1612.3)ml VS(2690.1±2495.7)ml,P<0.05].There was no significant difference in extubation time,ICU residence time,ventilator-assisted aerate time and hospital care expenses between the two groups(P>0.05).4.Kaplan-Meier survival curve analysis showed that there was no statistical difference between the incidence of postoperative mortality and incidence of postoperative adverse events(heart,brain,kidney and lung)with the time of onset between the two groups(P>0.05).5.Logistic regression analysis showed that continuous renal replacement therapy(OR:102.000,95%CI:14.231?731.079,P=0.000),cardiac arrest or ventricular fibrillation(OR:51.000,95%CI:2.286?1137.822,P=0.013)were independent risk factors for nosocomial death(B>0,OR>1).Postoperative RBC transfusion(OR:1.843,95%CI:0.742?0.957,P=0.009)were independent risk factors for postoperative complications(B>0,OR>1),and postoperative auxiliary ventilation time(OR:0.993,95%CI:0.986?1.000,P=0.047)were independent protective factors for postoperative complications(B>0,OR<1).Conclusion:1.The application of aPRP in aortic surgery can reduce the gross total of intraoperative allogeneic blood implantation,reduce the rate of allogeneic blood transfusion,and reduce postoperative drainage.This has a good blood protection effect.2.The application of aPRP in aortic surgery has no effect on the short-term prognosis of patients.