乌司他丁对体外循环冠脉搭桥患者凝血系统和血小板功能的影响

目的 探讨乌司他丁对体外循环冠状动脉旁路移植术患者凝血系统、血小板功能和术后出血的影响.方法 择期行体外循环(CPB)冠状动脉旁路移植术患者36例,随机分为对照组(C组,n=18)和乌司他丁组(U组,n=18).U组将乌司他丁40万单位溶于100 ml生理盐水中,自切皮开始静脉输注,30 min内输注完毕,另将40万单位加入CPB预充液中,另外20万单位以4～6万单位/h速率输注至术毕,总量100万单位,C组不用乌司他丁及任何抗纤溶药物.分别于切皮前1 min(基础值,T0),肝素化前1 min(此时U组已用乌司他丁40万单位,T1),术毕(T2),术后6 h(T3)和术后24 h(T4)经颈内静脉导管采血5 ml,用流式细胞仪测定血小板膜糖蛋白GPⅡb/Ⅲa和血小板α颗粒膜蛋白-140(CD62p),用比浊法测定激活部分凝血致活酶时间(APTT)、凝血酶原时间(PT)和纤维蛋白原,用硅藻土激活剂测定激活全血凝固时间(ACT).记录患者术后24 h出血量和输血量.结果 组间GPⅡb/Ⅲa、CD62p和PT,以及术后24 h出血量和同种输血量比较差异均无统计学意义(P>0.05).与基础值比较,U组APTT在T1、T3和T4均缩短(均P<0.05).与C组比较,U组:APTT在T1～4均缩短(均P<0.05),体外循环中ACT缩短,补充肝素量增加(P<0.01).结论 乌司他丁对血小板聚集和活性无影响,它能缩短APTT及肝素化后的ACT,增加CPB中补充肝素量,对内源性凝血系统有促进作用,该实验所用剂量未见减少CPB术后出血.

Effects of ulinastatin on coagulation and platelet function in patients undergoing coronary artery bypass grafting with cardiopulmonary bypass

Objective To investigate the effects of ulinastatin (U) on coagulation,platelet function,and postoperative bleeding in patients undergoing coronary artery bypass grafting (CABG) with cardiopulmonary bypass (CPB).Methods Thirty-six selective patients undergoing CABG with CPB were randomly assigned to two groups:Group U (n = 18) in which ulinastatin 4 × 106 U in 100 ml normal saline (NS) was infused intravenously for 30 min since skin incision with 4 × 106 U added to the CPB pump prime,and then 2 × 106 U of ulinastatin was infused intravenously at a rate of 4-6 × 104 U · h-1 until the chest was closed; and control group (Group C,n = 18) in which 100 ml NS was infused without ulinastatin.Peripheral blood samples were collected 1 rain before operation (T0 ),1 min before heparinization ( T1 ),at the end of operation ( T2 ),6 hour after operation ( T3 ),and 24 hour after operation ( T4 ).Platelet membrane glucoprotein Ⅱ b/Ⅲ a (GP Ⅱ b/Ⅲ a) and platelet α granule membrane protein-140 (CD62p) were measured by flow cytometry.Activated partial thromboplasin time ( APTT),activated coagulation time of whole blood (ACT),prothrombin time (PT),fibrinogen,and platelet number were also measured.Postoperative blood loss and aUogeneic transfusion were recorded.Results There were no statistical differences in CD26p,GP Ⅱ b/Ⅲ a,and PT between the 2 groups ( all P > 0.05 ).The APTT levels was significantly shortened in Group U at T1,T3 and T4 compared to T0.The APTT levels of Group U from T1 to T4 were all significantly lower than those of Group C ( all P < 0.05 ).The ACT levels after heparinization and during CPB in Group U were significantly shorter than those of Group C ( all P < 0.01 ),and the amount of added heparin during CPB of Group U was significantly higher than that of Group C ( P < 0.01 ).There were not significant differences in platelet amount,fibrinogen,total amount of blood loss in 24 h after operation was 960 (420,1500) ml in group C,and 850(380,1600) ml in group U (P>0.05).The platelet count,CD26p,GP Ⅱ b/Ⅲa,total amounts of blood loss and blood infusion 24 h after operation,and hemoglobin concentration between these 2 groups ( all P > 0.05 ).Conclusion Ulinastatin shortens the APTT and ACT after heparinization,increases the dose of heparin during CPB,has no effect on the expression of GP Ⅱ b- Ⅲa and CD62p,and does not reduce postoperative blood loss.