| Purpose: The purpose of this study was to investigate the blood protective effect and postoperative outcome of autologous platelet-rich plasma(a PRP)in patients with Stanford type An aortic dissection.The effects of different temperatures and different times on the activities of platelets and coagulation factors in platelet-rich plasma were compared,and the best preservation temperature was obtained to maximize the role of platelet-rich plasma in operation.Methods:Part 1 68 patients with Stanford type A aortic dissection treated in Tianjin Thoracic Hospital from January 2016 to October 2017 were randomly divided into platelet-rich plasma separation group(experimental group,n=32)and traditional blood management group(control group,n=36)according to the preparation of a PRP.There were 48 male patients and 20 female patients with BMI17.2～39.4kg/m2.APRP was isolated and prepared before operation in the experimental group,while the control group was not prepared with a PRP separation.Both groups used a blood recovery machine for autologous blood recovery.The platelet count was measured at 4 time points after anesthesia induction(after anesthesia induction and before whole blood separation in the experimental group),10min(T2)after protamine neutralization and blood products reinfusion,1 hour after operation(T3)and 24 hours after operation(T4).The general data of the patients were collected,including sex,age,body mass index,preoperative platelet count,operation time,cardiopulmonary bypass time,blocking time and circulatory arrest time.The number of blood products(red blood cells,plasma,platelets,cryoprecipitate transfusions)of the two groups were recorded.The postoperative drainage volume,postoperative complications,ventilator time,ICU stay time and hospital stay were recorded as well.Part 2 19 patients with Stanford type A aortic dissection treated in our hospital from May 2019 to August 2019 were selected for autologous platelet-rich plasma separation.3ml of platelet-rich plasma which could not be infused at the end of the blood preservation bag was extracted.The extracted 3ml was divided into three parts,1ml in each test tube,stored at different temperatures(4 ℃,22 ℃,37 ℃)and kept aseptic during the whole process.A variety of indicators,including platelet activated factor(CD62P),platelet activated complex-1(PAC-1),vascular endothelial growth factor(VEGF),platelet-derived growth factor(PDGF),coagulation factor Ⅴ and coagulation factor Ⅷ,were monitored at four time points,including the instant time of seperation(t1),2h(t2),4h(t3)and 8h(t4)of standing time,using enzyme-linked immunosorbent assay(ELISA).In 4 ℃ group,22 ℃ group and 37 ℃ group,the intra-group comparison of different preservation time and the comparison of different temperature under the same storage time were carried out in 4 ℃ group,22 ℃ group and 37 ℃ group.Results:Part 1(1)Comparison of general data: There is no significant difference in sex composition ratio,age and body mass index between the experimental group and the control group(P>0.05),and there is no statistically significant difference in platelet count between the two groups(P>0.05)).(2)There was no significant difference in platelet count between experimental group and control group at t1 time point(P>0.05).At T2,T3 and T4,the platelet counts of the two groups were statistically significant(P<0.05).(3)Allogeneic red blood cell input used in the experimental group was lower than that in the control group,which was statistically significant(P<0.05).The input of fresh frozen plasma and cryoprecipitate were lower than those of the control group,with statistical significance(P < 0.05).Fresh frozen plasma infusion and cryoprecipitation infusion were significantly lower than those in the control group(P<0.05).There was no significant difference in platelet transfusion between the experimental group and the control group(P>0.05).In the experimental group and the control group,the postoperative drainage volume in the experimental group decreased significantly,and the difference was statistically significant(P<0.05).There was no significant difference in postoperative mechanical ventilation time,ICU stay time,acute renal insufficiency,neurological complications and mortality between the two groups(P>0.05).Part 2 P-selectin(CD62P)and platelet activated complex-1(PAC-1)1 were compared in groups 4 ℃,22 ℃ and 37 ℃.(1)Comparison within the group: at 4 ℃,22 ℃,37 ℃ at different time points,there were no statistical difference between t2,t3,t4 and t1(P > 0.05).(2)Comparison between groups: There was no statistical difference between the three temperature groups at the same preservation time point(P>0.05).Coagulation factor Ⅴ,Ⅷ :(1)Comparison within the group: In the three groups of samples at 4 ℃,22 ℃,and 37 ℃,the value at t4 time point was statistically different from the value at t1 time point(P<0.05).There was no significant difference in other time points(P > 0.05).(2)Comparison between groups: There were no statistical difference among the three temperature groups(P>0.05).At t4 time,the 4 ℃ group and the 22 ℃ group were statistically different from the 37 ℃ group(P < 0.05).There was no statistical difference between the 4 ℃ group and the 22 ℃ group at t4time(P>0.05).Vascular endothelial growth factor(VEGF)and platelet-derived growth factor(PDGF):(1)Comparison within groups: at 4 ℃,22 ℃,37 ℃,different time points t2,t3,t4 were compared with t1,there were no statistics difference(P > 0.05).(2)Comparison between groups: There were no statistical difference between the three temperature groups at the same storage time point(P>0.05).Conclusion: 1.Autologous platelet separation,with the effect of blood protection,can reduce the transfusion of allogeneic red blood cells,plasma and cryoprecipitate during operation,reducing postoperative drainage.There were no significant difference in postoperative complications and prognosis.2.There were no significant difference in the activity and function of platelet and coagulation factors at different preservation temperatures of 4 ℃,22 ℃ and 37 ℃ within 4 hours.3.When the lasting preservation time of platelet-rich plasma reached 8 hours,the preservation in factor Ⅴ,Ⅷ,temperature of 4 ℃ and 22 ℃ was better than 37 ℃.. |
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