体外循环对血小板数量和功能的影响及机制

体外循环(ECC)后大多数患者血小板数量和功能均下降。一些患者在术后由于血小板数量减少或功能异常而出现凝血功能紊乱、出血、形成血栓、延长住院时间,甚至死亡。ECC本身,以及ECC期间使用的药物等均有可能导致患者血小板数量下降或功能异常。本文就ECC后血小板变化情况和其机制进行综述讨论以期对ECC期间及术后对血小板保护提供参考,改善心脏手术患者预后。     

体外循环对血小板的影响

目的 研究体外循环对血小板数量、功能的影响。方法 普通犬10只,进行体外循环,于体外循环前后选择不同时间点检测血小板计数、ADP诱导的血小板聚集功能、血小板膜表面糖蛋白(GPIb）、血小板膜表面α颗粒膜蛋白(GMP-140）分子数、血浆血栓素B2等血小板获得性损害相关指标并进行统计学分析。结果 体外循环期间血小板数量下降,ADP诱导的血小板聚集功能受损,GPIb分子数减少,GMP-140分子数及血浆血栓素B2浓度均上升。结论 体外循环过程中,血小板数量急剧下降;聚集及粘附功能受损;血小板内α颗粒释放增加;血小板膜GPIb分子数下降;血小板内前列腺素代谢增强。     

体外循环对心瓣膜替换病人的血小板数量和功能的影响

体外循环 (ＣＰＢ)可破坏血液有形成分 ,使血小板激活、大量消耗 ,影响血小板数量和功能。本研究通过测定心瓣膜替换病人ＣＰＢ围术期血小板粘附率、最大聚集率及数量 ,探讨ＣＰＢ对血小板数量和功能的影响及其与ＣＰＢ时间、氧合器类型及性别、血型、输血量等因素的相关性。对象和方法一、一般资料体外循环心瓣膜替换手术病人 2 0例 ,男 8例 ,女 1 2例。平均年龄 5 0 .2 5 (30～ 5 3)岁 ,平均体重 46 .5 7(36～ 6 3)ｋｇ。其中二尖瓣替换 1 6例 ,二尖瓣、主动脉瓣替换 4例。应用美国Ｓａｒｎｓ 740 0型血泵、国产科威 87型鼓泡式氧合器(Ｋ…     

体外循环对血小板代谢的影响

本文检测了10例体外循环患者血浆内TxB_2、6—酮—PGF_(1a)、PF_4及vWF 的浓度变化,结果为:TxB_2于肝素化后及转流开始出现第一次高峰,转流结束及鱼精蛋白中和后出现第二次高峰,术后2h 恢复正常,6—酮—PGF_(1a)无显著性改变;PF_4于转流后开始升高,转流结束达高峰,术后24h 恢复正常;vWF 于转流结束开始升高,术毕与术后2h 为高峰,24h 恢复正常.这—研究有利于判断体外循环中血小板的功能变化。     

体外循环心内直视手术时血小板聚集功能和数量变化的初步观察

本文观察到23例体外循环心内直视手术病人转流时血小板聚集功能均有下降,尤以紫绀型先心病人为甚,讨论了体外循环时血小板遭破坏之诸因素,并提出了必要的预防措施。     

尼莫地平、尼群地平与阿斯匹林协同抗血小板聚集

尼莫地平、尼群地平与阿斯匹林协同抗血小板聚集任亚军，张贵卿，吕爱刚，张连海河南医科大学药理学教研室郑州４５００５２关键词尼莫地平，尼群地平，阿斯匹林，抗血小板聚集阿斯匹林（ａｃｅｔｙｌｓａｌｉｃｙｌｉｃａｃｉｄ，ＡＳＡ）和钙拮抗剂配伍应用治疗心脑血管...     

鱼油制剂对实验性球囊血管成形术中血小板数量及粘附聚集功能的影响

本实验建立了兔右髂动脉粥样硬化狭窄模型，观察鱼油制剂在球囊血管成形术中对血小板的影响。结果表明，本实验用药剂量对血小板数无影响，但能明显抑制血小板粘附、聚集功能，理论上有助于减轻成形术局部血小板与血管壁的相互作用，一定程度上抑制局部血栓形成及血管内膜平滑肌细胞增生。     

水蛭注射液对大白鼠血小板粘附和血小板聚集功能的影响

目的　探讨水蛭注射液对大白鼠血小板粘附性和聚集性的影响。方法　采用大白鼠 2 4只 ,随机分成两组 ,实验组给药 ,对照组以实验组同样的方法和剂量给予生理盐水 ,5d后由颈总动脉取血 ,做血小板粘附性和聚集性试验。结果　水蛭注射液对大鼠血小板粘附性和聚集性具有显著的抑制作用 ,实验组与对照组抑制率有显著的统计学意义 (P <0 0 0 1)。结论　水蛭注射液能够抑制大白鼠血小板的粘附和聚集。     

体外循环对血小板功能及血管张力相关因子影响

1目的　探讨体外循环 (CPB)对血小板激活状态及血管张力相关因子的影响。2方法　分时段测定2 0例心脏直视手术病人 CPB前后血浆颗粒膜蛋白 (GMP- 140 )、血栓烷 B2 (TXB2 ) ,6 -酮 -前列腺素 F1α(6 - K- PGF1α) ,心钠素 (ANP)及内皮素 (ET)的变化。3结果　 GMP- 140 ,TXB2 和 ANP测得值随着 CPB进行均逐渐增加 ,停机后1h与肝素化 10 min相比 ,GMP- 140 ,TXB2 ,TXB2 / 6 - K- PGF1α和 ANP均显著增加 (F=5 .38～ 7.76 ,q=3.38～ 5 .5 2 ,P<0 .0 5 ,0 .0 1) ;而 6 - K - PGF1α和 ET在 CPB前后变化不明显 (F =2 .16 ,2 .2 7,P>0 .0 5 )。4结论　 CPB后血小板功能损害加重 ,ANP分泌增加。     

儿童体外循环心脏手术对甲状腺功能的影响

目的 观察儿童体外循环心脏手术前后甲状腺激素的变化,了解体外循环心脏手术对儿童甲状腺功能的影响并探讨其临床意义。方法 用放射免疫方法测定２５例外循环心脏手术儿童术前、术中、术后甲状腺激素和促甲状腺激素的含量。结果 体外循环期间血浆三碘甲状腺原氨酸（ｔｅｔｒｏｄｏｔｈｙｒｏｎｉｎｅ,Ｔ３）、游离三碘甲状腺原氨酸（ｆｒｉｉ ｔｒｉｉｏｄｏｔｈｙｒｏｎｉｎｅ,ＦＴ３）、四碘甲状腺原氨酸（ｔｅｔｒａｉｏｄ     

EFFECT OF CARDIOPULMONARY BYPASS ON PULMONARY FUNCTION IN INFANTS

Objective To evaluate the effect of the cardiopulmonary bypass （CPB） on the pulmonary function in infants with or without pulmonary hypertension in congential ventricular septal defect （VSD）. Methods Twenty infants with VSD were enrolled in the study from Jan. to Dec. 2004. They were divided into two groups： pulmonary hypertension group and non-pulmonary hypertension group, ten infants respectively. Pulmonary function parameters were measured before CPB and 3, 6, 9, 12, 15, 18, 21, 24h after CPB, the following data were recorded： duration for mechanical ventilation （Tmv） and staying in the cardiac intensive care unit （Tcicu） after cardiac surgery. Results Before CPB, the pulmonary function parameters in non-pulmonary hypertension group were more superior than in pulmonary hypertension group （ P 〈 0. 01 ）. By contraries, the pulmonary function parameters in every time stage after CPB statistically significant decreased in non-pulmonary hypertension group （ P 〈 0. 05 ）, especially at 6, 9, and 15h after CPB （ P 〈0. 01 ）. In pulmonary hypertension group, the pulmonary function parameters in 3h after CPB were more improved than before CPB, though there was no statistical significance. But they had statistically significant decreased at 9, 12, 15h after CPB （ P 〈0. 05）. There was a similar change in pulmonary function between two groups at 21,24h after CPB. Conclusion Exposure to CPB adversely affects pulmonary function after surgical repair of VSD in infants. We consider that the benefits of the surgical correction in infants with pulmonary hypertension outweight the negative effects of CPB on pulmonary function. We should improve cardiac function to avoid the presence of the nadir trough in pulmonary function. The infants with pulomonary hypertension also have ability to wean from mechanical ventilation as soon as possible, if the hemodynamics is stable, and without the responsive pulmonary hypertension or pulmonary hypertension crisis after surgical repair.     

绵羊二尖瓣置换术体外循环方法学的探讨

目的 :探讨绵羊二尖瓣置换术体外循环的方法 ,以配合国产双叶瓣膜的研制。　方法 :对 5只绵羊作体外循环下国产双叶瓣二尖瓣置换术 ,总转机 78分钟 ,主动脉阻断 6 2分钟。　结果 :3只长期存活 :其中 1只 6个月后处死作组织学解剖 ,2只存活至今 ;另 2只 :1只存活 1周后死于抗凝不足 ,1只术后 12小时死于急性肺水肿。　 结论 :本研究所采用的体外循环方法符合绵羊二尖瓣置换术的要求。     

抑肽酶对体外循环心脏直视手术患者血液纤溶活性的影响

将４８例先天性心脏病和风湿性心脏病患者分层后随机均分为四组。对照组不给抑肽酶，小、中、大剂量组分别给予抑肽酶１．５、３．０、６．０万ＫＩＵ·ｋｇ－１一次性加入预充液。用药组血浆中Ｄ－二聚体含量在体外循环（ＣＰＢ）末及术后１ｈ均较对照组明显减少（Ｐ＜０．０１），表明抑肽酶对ＣＰＢ过程中继发性纤溶亢进有一定的抑制作用。这可能为抑肽酶减少ＣＰＢ术后失血的机制之一。     

FORMATION OF SOLID PARTICLES IN BLOOD STREAM AND EFFECTS ON PULMONARY ULTRASTRUCTURE DURING CARDIOPULMONARY BYPASS IN CHILDREN

An electronic particle size analyzer (Coulter Counter ZM) was utilized to quantitate the particulate microemboli, varying from 15 to 80μin size, during cardiopulmonary bypass. We confirmed the main causes of microemboli were banked blood, cardiotomy reservoirs and oxygenators. Electronic microscopic examination showed that a large number of solid particles more than 20μin size were formed during heart-lung bypass, which obstructed microcirculation and damaged the pulmonary capillary endothelial and alveolar epithelial cells. The degree of histological damage was related to the number and size of microemboli and time of pulmonary microcirculatory obstruction.     

COMPLEMENT ACTIVATION AND CONSUMPTION DURING CARDIOPULMONARY BYPASS FOR OPEN HEART SURGERY

Fourteen patients undergoing cardiopulmonary bypass for open heart surgery were studied for their complement activation and consumption. We determined quantitatively the complement components C3 and C4 and qualitatively the complement breakdown product C3d and found that C3 decreased during the bypass while C4 diminished at the termination of bypass and again after protamine administration. C3d was positive in every patient measured at the end of bypass. The rapid activation of complement during bypass is mainly through alternate pathway whereas activation at the end of bypass and after protamine administration are through both classic and alternate pathways. We failed to demonstrate leukopenia during bypass. Further study should be made to clarify the relationship between complement activation, leukopenia and the postoperative pulmonary dysfunction. It is necessary to develop new and more physiological materials for extracorporeal circuit.     

MECHANISM OF PRESERVING EFFECT OF APROTININ ON PLATELET FUNCTION DURING CARDIOPULMONARY BYPASS

The deficiency of platelet function is the main defect of hemostatic mechanism during cardiopulmonary bypass (CPB), which attributed to the postoperative bleeding complication to a great extent. The proteinase inhibitor aprotinin was reported to have preserving effect on platelet adhesion during CPB. In this clinical reserch we found that CPB caused plasma alpha 2-antiplasmin decreasing, indicating the fibrinolytic system activation. Meanwhile, the ristocetin-induced aggregation declined to 39.6% and platelet GPIb decreased to 50% of preoperative value. However, by treatment with aprotinin, the plasma alpha 2-antiplasmin during CPB did not change, platelet aggregation was improved and platelet GPIb was preserved, and consequently resulted in a 46% lower blood loss postoperatively. These results confirmed that aprotinin could inhibit the fibrinolysis during CPB, and thus relieve the platelet damage and improve the postoperative hemostatic mechanism.     

心不停跳心内直视术体外循环初期低血压对肾功能的影响

目的:探讨体外循环(cardiopulmonary bypass,CPB)初期低血压对肾功能的影响。方法:择期行心不停跳二尖瓣置换术患者42例,随机分为观察组(D组)和对照组(C组),两组CPB开始时平均动脉压(mean arterial pressure,MAP)在5.33～8.67kPa,MAP≥8.67kPa剔除,观察中D组和C组各有1例退出研究,最终每组20例,D组转流15min内MAP在5.33～8.67kPa,C组转流15min内MAP在8.67～10.67kPa。两组患者分别于手术前(T0)、手术结束(T1)、术后6h(T2)、12h(T3)、24h(T4)、48h(T5)采集静脉血,用于检测肌酐(SCr)、尿素氮(BUN)、α1微球蛋白(α1-MG)的水平。结果:与T0比较,T3、T4时点C组BUN升高(P<0.01),T2、T3、T4、T5时点D组BUN升高(P<0.01),T3、T4、T5时点C组SCr升高(P<0.05或P<0.01),T2、T3、T4、T5时点D组SCr升高(P<0.01),T2、T3时点C组α1-MG升高(P<0.05或P<0.01),T2、T3、T4时点D组α1-MG升高(P<0.05或P<0.01)。与C组比较,T5时点D组BUN升高(P<0.05),T2、T5时点D组SCr升高(P<0.05),T1、T2时点D组α1-MG升高(P<0.05)。两组患者围术期均未发现血红蛋白尿,都没有发生术后急性肾功能衰竭。结论:心不停跳心内直视术CPB初期不同血压水平对术后肾功能均有影响,以CPB初期低血压对患者肾功能影响较大。     

体外循环对机体免疫功能的影响

检测实验组（３５例体外循环心脏手术）、对照组（１０例非体外循环心脏手术）患者术前、术中和术后第３、８天外周血红细胞Ｃ３ｂ受体花环率、红细胞免疫复合物花环率，Ｔ淋巴细胞亚群，白细胞、淋巴细胞计数，血清免疫球蛋白、补体水平。结果显示：实验组红细胞免疫功能、Ｔ淋巴细胞免疫功能、淋巴细胞数量、免疫球蛋白和补体水平均较术前显著下降（Ｐ＜０．０１，Ｐ＜０．０５），持续至术后３～８ｄ。提示体外循环的非搏动性血流、气血界面、泵管挤压、心内吸引及人工管道系统均可导致血液有形成分破坏、血浆蛋白变性、补体激活和消耗，损害机体的细胞免疫和体液免疫功能。     

过氧化脂质对体外循环中红细胞的影响

以１４例小儿体外循环（ＣＰＢ）心内直视手术病例为对象，研究ＣＰＢ中过氧化脂质（ＬＰＯ）与红细胞损伤之间的关系。发现ＣＰＢ使血浆游离血红蛋白（ＰＦ－Ｈｂ）明显升高，扫描电镜见红细胞形态发生改变，体积增大，红细胞表面积与体积之比值下降，提示ＣＰＢ可造成红细胞破坏。血浆ＬＰＯ在ＣＰＢ期间明显升高，且与ＰＦ－Ｈｂ呈直线相关关系，ｒ＝０．７８，Ｐ＜０．０５，说明氧自由基介导的脂质过氧化损害是造成体外循环中红细胞破坏的因素之一。