关键词: 自体血小板分离回输技术, 急性A型主动脉夹层, 凝血功能, 肝肾功能保护, 血液保护

Abstract: Objective To investigate the clinical effect of autologous plateletpheresis (APP) transfusion in patients with acute type A aortic dissection (ATAAD). Methods The clinical data of 125 ATAAD patients admitted to our hospital from January 2020 to April 2023 were retrospectively analyzed. The patients were divided into APP group (n=59) and non-APP group (n=66) based on whether APP and transfusion performed. The levels of coagulation indexes and liver and kidney indexes were recorded at preoperative (T0), 24 h postoperative (T1), 48 h postoperative (T2), and 72 h postoperative (T3). Platelet count, the amount of allogeneic blood transfusion, duration of surgery, duration of mechanical ventilation, volume of mediastinal drainage in the postoperative period, length of stay in the ICU, hospitalization cost, and rate of postoperative complications were recorded. Results At T1-T3, PT and APTT in the APP group were significantly shorter than those in the non-APP group (P<0.05), and the level of FIB was higher than that in the non-APP group (P<0.05). The liver function parameters after operation were observed. Compared with the non-APP group, the levels of ALT and AST in the APP group were relatively lower at T1 and T2 (P<0.05); LDH was maintained at lower levels at T1, T2, and T3 (P<0.05); the levels of DBil and TBil were lower than those in the APP group at T1 (P<0.05). Postoperative renal function parameters were observed. SCr and BUN levels in the APP group were significantly lower than those in the non-APP group at T1, T2, and T3 (P<0.05). From blood protection, compared with the non-APP group, PLT in the APP group maintained a high level at T1 (P<0.05), and the amount of perioperative allogeneic red blood cells, platelets, plasma and cryoprecipitate transfusion in the APP group was relatively lower (P<0.05). The postoperative outcomes were observed. Compared with the non-APP group, duration of mechanical ventilation and length of stay in the ICU in the APP group were shorter; total hospitalization cost was lower; the volume of mediastinal drainage at 24 h after surgery was lower (P<0.05). The postoperative complications were observed. The incidence of acute kidney injury in the APP group was significantly lower than that in the non-APP group (P<0.05). Conclusion Autologous plateletpheresis and transfusion technology can effectively improve the coagulation function of ATAAD patients and have obvious effects on postoperative liver and kidney function protection and blood protection, and accelerate postoperative recovery and regression. The application of this technology is helpful to reduce the economic burden of patients and achieve good social and economic effects.

Key words: Autologous plateletpheresis and transfusion technique, Acute type A aortic dissection, Coagulation function, Liver and kidney function protection, Blood protection