■心血管手术通常需要深低温停循环和体外循环(CPB),这会破坏血液凝固并导致过度出血。传统的治疗方法包括输血和血液制品,这可能会产生不利影响,并对全球血液供应造成重大压力。研究表明,自体富含血小板的血浆置换(aPRP)可以通过保留血液成分来减少输血的需要。然而,aPRP对心血管手术术后失血量和临床结局的影响仍存在争议.本研究旨在研究aPRP对心脏瓣膜手术患者术后失血和恢复的影响。
■总共183例患者被分为aPRP组和对照组。aPRP组在CPB之前接受了aPRP,而对照组没有。主要终点是两组之间的术后出血。次要终点是术后出血危险因素和临床结局评估。使用带有协变量调整的Logistic回归分析来计算这些危险因素。
■分析包括aPRP组的76例患者(41.5%)和对照组的107例患者(58.5%)。术后出血发生率差异无统计学意义[比值比(OR)=0.53,95%置信区间(CI):0.28~1.00,P=0.05],aPRP组的并发症少于对照组(OR=0.28,95%CI:0.10-0.68,P=0.009)。然而,在调整纽约心脏协会(NYHA)分类后,糖尿病,心律失常学,平均激活凝血时间(ACTmean),CPB,出血,开胸手术,和体重指数(BMI),两组患者术后出血(校正后OR=0.47,95%CI:0.22~0.98,P=0.04)和并发症(校正后OR=0.23,95%CI:0.07~0.64,P=0.008)差异有统计学意义.
■术前aPRP可以改善心脏瓣膜手术患者的术后预后并减少并发症。
UNASSIGNED: Cardiovascular surgeries often require deep hypothermic circulatory arrest and cardiopulmonary bypass (CPB), which can disrupt blood clotting and lead to excessive bleeding. Traditional treatments involve transfusing blood and blood products, which can have adverse effects and place significant strain on the global blood supply. Research suggests that autologous platelet-rich plasmapheresis (aPRP) may reduce the need for transfusions by preserving blood components. However, the impact of aPRP on postoperative blood loss and clinical outcomes in cardiovascular surgery remains controversial. This study aimed to examine the effects of aPRP on postoperative blood loss and recovery in patients undergoing heart valve surgery.
UNASSIGNED: A total of 183 patients were divided into either aPRP or control groups. The aPRP group received aPRP before CPB, whereas the control group did not. The primary endpoint was postoperative bleeding between the groups. The secondary endpoints were postoperative bleeding risk factors and clinical outcome assessment. Logistic regression analysis with covariate adjustment was used to calculate these risk factors.
UNASSIGNED: A total of 76 patients (41.5%) in the aPRP group and 107 patients (58.5%) in the control group were included in the analysis. No significant difference was found in the occurrence of postoperative bleeding [odds ratio (OR) =0.53, 95% confidence interval (CI): 0.28-1.00, P=0.05], and the aPRP group had fewer complications than the controls (OR =0.28, 95% CI: 0.10-0.68, P=0.009). However, after adjusting for the New York Heart Association (NYHA) classification, diabetes, arrhythmology, mean activated clotting time (ACTmean), CPB, bleeding, thoracotomy, and body mass index (BMI), there was a significant difference in postoperative bleeding (adjusted OR =0.47, 95% CI: 0.22-0.98, P=0.04) and complications (adjusted OR =0.23, 95% CI: 0.07-0.64, P=0.008) between the two groups.
UNASSIGNED: Preoperative aPRP can improve postoperative outcomes and reduce complications in patients undergoing heart valve surgery.