体外循环对血小板凝血酶敏感蛋白及纤维蛋白原含量的影响

目的　探讨体外循环心肺转流术 (CPB)期间血小板的灭活机制及临床意义。方法　用流式细胞术观察 40例先天性心脏病房、室间隔缺损患者在CPB下行心内修补术时的血小板凝血酶敏感蛋白 (Ts)及纤维蛋白原 (Fg)含量的变化 ,同时与本组患者试管内血小板Ts及Fg含量进行比较。结果　体外循环中血小板总数明显下降 ,从术前的 (310± 91)× 10 6/L降至术后的 (181± 44 )×10 6/L ,Ts及Fg含量均较术前有明显增加 (P <0 0 1) ,而试管内测定与之不符。结论　CPB期间Ts及Fg明显增加 ,表明Ts及Fg的粘附凝集功能增强 ,而凝血机制缺陷的原因可能与血小板总数下降、低温及肝素的后续作用有关。     

体外循环期间血小板膜糖蛋白的定量研究及临床意义

目的　探讨体外循环 (CPB)对血小板膜糖蛋白的影响。方法　用流式细胞术对 40例先天性心脏病房、室间隔缺损患者在 CPB下行心内修补术时的血小板膜糖蛋白 CD41 a、CD42 b、CD6 2 p和CD6 3的含量免疫荧光定量测定 ,同时与本组患者和健康供血者试管内血小板膜糖蛋白进行比较。结果　在 CPB中血小板总数明显下降 ,从术前值的 (310± 91)× 10 3/ m l降至术后值的 (181± 44 )× 10 3/ml,CD41 a无明显变化 ,CD42 b明显降低 (P<0 .0 5 ) ,CD6 2 p和 CD6 3明显增加 (P<0 .0 5 )。本组和健康供血者的试管内血小板膜糖蛋白 CD41 a、CD42 b、CD6 2 p和 CD6 3均呈平行变化。结论　 CPB期间既有粘附凝集功能下降 ,也有粘附凝集功能增强的血小板膜糖蛋白 ,而凝血机制缺陷的原因可能与血小板总数下降、低温及肝素的后续作用有关。     

体外循环心脏直视手术中红细胞携氧能力的临床观察

目的　观察体外循环 (CPB)心脏直视手术中红细胞携氧能力的变化。方法　观察 1 5例择期心脏手术病人的红细胞形态、P5 0和红细胞内 2 ,3 二磷酸甘油酸 (2 ,3 DPG)的含量在围转流期的变化。结果　红细胞在CPB期间发生畸形变 ;红细胞内 2 ,3 DPG的浓度在CPB结束时较术前明显增加[(7 82± 1 5 5 ) μmol/ml对 (6 39± 1 2 7) μmol/ml,P <0 0 5 ];P5 0在转流前后无明显变化。 结论　尽管红细胞的形态在CPB期间有所改变 ,但其携氧能力变化不明显。     

抑肽酶对血小板膜糖蛋白功能影响的实验研究

目的 研究体外循环期间抑肽酶对血小板保护作用的分子学机制。方法 ２０例健康供血者的静脉血注入含枸橼酸或肝素的试管中,用流式细胞术检测抑肽酶对血小板膜糖蛋白ＧＰⅡｂ－Ⅲａ受体及Ｐ－选择素表达的影响。结果 抑肽酶在５０～２００Ｕ／ｍｌ时可减少ＡＤＰ和凝血酶受体激活肽６激活的血小板膜糖蛋白ＧＰⅡｂ－Ⅲａ受体的表达（Ｐ〈０．０５）,但对Ｐ－选择素表达无影响。结论 抑肽酶减少激动剂诱导的活化血小板膜糖蛋白Ｇ     

抑肽酶对血小板膜糖蛋白功能的影响

目的：探讨抑肽酶对心转流（CPB）期间血小板功能的保护作用。方法：选择20例先天性心脏病房,室间隔缺损在CPB下行心内修补术的病人,随机分为对照组（不加抑肽酶）和抑肽酶组（加抑肽酶200万KIU）,每组10例,分别测定不同时间点的血小板计数和血小板膜糖蛋白GP Ⅰb,GPⅡb-Ⅲa的表达。结果：与对照组相比,抑肽酶组血小板计数和血小板膜糖蛋白GPⅠb,GPⅡb-Ⅲa的表达减少明显减轻（P＜0．05）,术后出血也明显减少,结论：抑肽酶在体外循环期间可抑制血小板计数和血小板膜糖蛋白GPIb和GPⅡb-Ⅲa的减少,对血小板功能具有保护作用。     

体外循环期间心腔血血小板膜糖蛋白Ib含量的变化

目的：探讨心肺转流（CPB）体外循环期间心腔血血小板膜糖蛋白Ib的变化及与凝血的关系。方法：用流式细胞术对40例先天性心脏病房或室间隔缺损患者在CPB下行心内修补术时的心腔血血小板膜糖蛋白Ib免疫荧光定量测定,同时与本组体外循环全血比较。结果：全血血小板膜糖 蛋白Ib在选定的三个时点分别下降10％、28％和25％,而心腔血则都下降50％以上。结论：CPB期间心腔血血小板表面膜糖蛋白Ib明显减少,已无凝血功能。     

止血芳酸对体外循环中血栓素A2、前列腺环素的影响

目的 通过观察止血芳酸（PAMBA）对体外循环（CPB）心脏手术中血栓素A2（TXA2）、前列腺环素（PGI2）对影响，探讨其对CPB中血小板功能的保护作用。方法 40例择期CPB心脏手术病人，随机分为两组（每组20例），观察组（A组）于CPB前、CPB预充液中以及鱼精蛋白中和后10min，经中心静脉分别给予PAMBA250mg；对照组（B组）分别给予等容量的生理盐水。分别在切皮前、CPB开始后30min、CPB停机及手术结束时检测血小板计数，采用ELISA法测定血浆TXB2和6－keto-PGF1α的浓度。结果 CPB前两组血小板计数无明显差异。转流后两组各时点和基础值相比显著下降（P＜0.01)，但A组和B组相比血小板计数降低程度明显减轻（P＜0.05)；B组TXB2明显升高，6-keto-PGF1α与转流前比较有所升高，TXB2／6-keto-PGF1α比值明显升高；观察组TXB2的增加及TXB2／6-keto-PGF1α比值明显低于对照组（P＜0.01)，而6-keto-PGF1α的增加则明显高于对照组（P＜0.05)。结论 CPB前和CPB中给予PAMBA有利于维持TXA2和PGI2在体内的平衡，从而在一定程度上保护了血小板的功能，显著减少了CPB和术后非外科性出血。     

肝素涂层管道对体外循环中血小板的保护作用

目的：探讨常规剂量肝素体外循环（CPB）下使用肝素涂层CPB管道（HCC）对血小板的影响。方法：机械瓣膜置换术患者随机分为HCC组（n=8）和对照组（n=15）。分别在CPB前、CPB60min、肝素中和后30、60min及手术后12h测定血小板计数（PLT），血浆α颗粒膜蛋白－140（GMP－140）的浓度及手术后12h出血量。利用电子显微镜观察两组转流后微栓过滤网上沉积物的附着情况。结果；对照组PLC在转流中、后显著低于HCC组，差异有显著性（P＜0．05），且血浆GMP－140浓度在转流60min、转流中和后30、60min显著高于HCC组，差异有显著性（P＜0．05），但手术后12h差异无显著性（P＞0．05）；HCC组手术后12h出血量较对照组少，差异有显著性（P＜0．05）；HCC组动脉过滤网表面光洁，网眼边缘清晰，偶见白细胞和血小板附着；对照组动脉过滤网表面可见纤维蛋白沉积，网眼边缘模糊，有大量白细胞及少数活化血小板粘附。结论：HCC在CPB中对血小板具有保护作用，较好地改善CPB装置的血液相容性。     

心脏不停跳心内直视手术与神经元损伤

目的　对比观察心脏不停跳与传统的心内直视手术对神经元的损伤情况。方法　 1 0 3例体外循环 (CPB)心内直视手术病人随机分为两组 :心脏不停跳组 (试验组 ) 51例 ,术中不阻断升主动脉 ,CPB中鼻咽温度为 32～ 34℃ ;心脏停跳组 (对照组 ) 52例 ,术中阻断升主动脉 ,CPB中鼻咽温度为 2 5～2 7℃。动态监测围术期所有病人颈内静脉血中S 1 0 0 β蛋白和神经元特异性烯醇酶 (NSE)的水平变化。结果　两组术中及术后早期 ,S 1 0 0 β蛋白和NSE水平明显高于术前 (P <0 0 5或P <0 0 1 ) ,其中S 1 0 0 β蛋白术后 3d恢复至术前水平 ,NSE术后 1d恢复至术前水平 ;试验组S 1 0 0 β蛋白从转流 2 0min到术后 1d明显低于对照组 (P <0 0 5或P <0 0 1 ) ,NSE从转流毕到术后 8h明显低于对照组 (P <0 0 5或P <0 0 1 ) ;试验组术后出现精神异常 1例 ,对照组术后出现偏瘫 2例。结论　颈内静脉血中S 1 0 0 β蛋白和NSE的水平变化 ,尤其是前者可作为评价心内直视手术对神经元损伤程度的可靠指标 ;心脏不停跳心内直视手术对神经元的损伤比传统的手术方式轻。     

体外循环中氨甲苯酸对血小板的保护作用

目的：探讨氨甲苯酸（AMBA）在心肺转流（CPB）中对血小板的保护作用及其临床意义。方法：测定AMBA组和对照组血小板数量出血量和输血量以及CPB前后血浆α－颗粒膜蛋白（GMP－140），血栓烷B2（TXB2）和6－酮－前列腺素F1α（6－K－PGF1a)的浓度变化。结果：CPB术后，AMBA组血小板计数明显高于对照组，出血量明显少于对照组，AMBA组GMP－140和TXB2上升幅度小，而对照组上升幅度大（P＜0．05）。结论：氨甲苯酸在CPB术中可以起到保护血小板，减少术后出血的作用。     

体外循环中止血芳酸对血小板的保护作用

目的：探讨止血芳酸在体外循环中对血小板的保护作用及其临床意义。方法：测定止血芳酸组和对照组血小板数量、出血量和输血量,及体外循环前后血浆α－颗粒膜蛋白（ＧＭＰ－１４０）,血栓烷Ｂ２（ＴＸＢ２）和６－酮－前列腺素Ｆ１a(6-k-PGF1a）的浓度变化。结果,体外循环术后血小板计数组明显高于对照组,出血量明显少于对照组。ＧＭＰ－１４０、ＴＸＢ２上升幅度小于对照组,二者相比差异显著（Ｐ＜０．０５）。结论：止血芳酸在体外循环术中可以起到保护血小板,减少术后出血的作用。     

Cardiopulmonary bypass induces significant platelet activation in children undergoing open-heart surgery

BACKGROUND AND OBJECTIVES: To evaluate the effects of cardiopulmonary bypass (CPB) on platelet function in children undergoing open-heart surgery. METHODS: Data from 16 consecutive children undergoing cardiac surgery with CPB were prospectively collected. Blood samples of 10 mL were collected via the central venous line immediately before and after CPB for CD62 measurements by flow cytometry. RESULTS: Ten children had acyanotic heart disease (median age 3 yr, range 1.8-14) and six had a cyanotic defect (median age 4yr, range 2-14). The platelet count decreased significantly with CPB in both groups: from 163.5 (130-201) to 93.5 (57-186) x 10(3) microL(-1) in acyanotic children and from 139.5 (77-212) to 75 (43-99) x 10(3) microL(-1) in cyanotic children (P < 0.0001). The percentage of activated platelets was significantly lower in acyanotic children at baseline: 1% (0-23%) vs. 5% (3-8%) (P = 0.07). CPB increased the percentage of activated platelets significantly in both groups: post-bypass the values were 10% (range 1-17%) in acyanotic children and 7% (range 1-30%) in cyanotic children (P = 0.03). The increase in the percentage of activated platelets did not differ between the two study groups (P = 0.11). CONCLUSION: CPB induces significant platelet activation in children undergoing open-heart surgery.     

1，6—二磷酸果糖对体外循环期间中性粒细胞的影响

目的　研究体外循环下 1,6 二磷酸果糖 (FDP)对中性粒细胞 (PMNs)活化、释放的影响。方法　 2 0例先心病矫正术患者随机分成使用FDP( 2 2 0mg/kg)的观察组 (n =10 )和对照组 (n =10 ) ,动态观察中性粒细胞化学发光 (PMN CL)值、中性粒细胞内髓过氧化物酶 (MPO)及弹性蛋白酶(ELA)活性。结果　 ( 1)与阻断主动脉时对比 ,两组各时点PMN CL值均明显升高 (P <0 0 5、P <0 0 1或P <0 0 0 1) ,PMN MPO及ELA活性降低 (P <0 0 5或P <0 0 1) ,化学发光最高值、MPO及ELA活性最低值出现在主动脉开放后 (再灌注 ) 4 5分钟。 ( 2 )与对照组相比 ,在主动脉阻断 3 0分钟、主动脉开放后 (再灌注 ) 4 5分钟及 90分钟 ,观察组PMN CL值降低 ,PMN MPO及ELA活性升高 (P<0 0 5或P <0 0 1)。结论　 ( 1)体外循环时PMNs活化并释放多种活性物质 ,且主要发生于主动脉开放后 (再灌注 )早期。 ( 2 )FDP抑制PMNs的活化 ,减轻了PMNs的释放反应。     

尼莫地平对体外循环过程中脑氧耗与脑糖利用的影响

目的：观察体外循环心肺转流（ＣＰＢ）期间脑氧耗与脑糖利用相关性及尼莫地平对其影响。方法：３５例心脏直视手术病人随机分为对照组（ｎ＝１５）和观察组（ｎ＝２０）．监测ＣＰＢ期间不同时期的桡动脉和颈内静脉上球部ＰａＯ２、ＰｊＯ２、ＳａＯ２、ＳｊＯ２及血糖（Ｇ）的变化,并分析Ｃａ－ｊＯ２与Ｇａ－ｊ的关系。结果：两组Ｃａ－ｊＯ２与Ｇａ－ｊ于ＣＰＢ期间均进行性下降,与术前有显著性差异（Ｐ〈０．０１）;观察组Ｇ     

The effects of aprotinin on platelet function in blood exposed to eptifibatide: an in vitro analysis

The preoperative use of platelet inhibitors has increased the risk of bleeding during cardiac surgery. Aprotinin has been shown to preserve hemostatic function in patients undergoing CPB. The purpose of this study was to investigate the effect of aprotinin on coagulation in blood exposed to eptifibatide. Freshly collected bovine blood was used in an in vitro model of extracorporeal circulation. Blood was separated into two groups: activated (60 minutes exposure to bubble oxygenation) and nonactivated. Within each group there were four subgroups: control (n = 3), eptifibatide (2.8 microg/mL, n = 3), aprotinin (250 KIU/mL, n = 3), and eptifibatide with aprotinin (2.8 microg/mL, 250 KIU/mL, n = 3). Twenty-four modified extracorporeal circuits utilizing a hard-shell venous reservoir and cardioplegia heat exchangers were used. Blood flow was maintained at a rate of 1.25 L/min for a total of 170 minutes, at 37 +/- 1 degree C. Samples were collected at 0, 20, 50, and 110 minutes with the following variables measured: thromboelastograph (TEG), activated clotting time (ACT), and hematocrit (Hct). Results demonstrated that at 110 minutes, the TEG index (TI) was decreased by four-fold in the activated group compared to the nonactivated group (-4.6 +/- 1.2 vs. 1.4 +/- 1.5, p < .05). The administration of aprotinin resulted in preservation of the TI as compared to eptifibatide-treated blood (-4.9 +/- 1.2 vs. -7.9 +/- 1.2, p < .05). Aprotinin combined with eptifibatide reduced coagulation derangements when compared to eptifibatide alone (-5.2 +/- 1.2 vs. -7.9 +/- 1.2, p < .05). In conclusion, aprotinin attenuated the platelet inhibition effect of eptifibatide during in vitro CPB, resulting in improved coagulation.     

浅低温体外循环冠脉搭桥患者术中氧供和氧耗变化

观察浅低温体外循环冠脉搭手术期间患者氧供和氧耗的变化特点。方法：冠脉搭桥术患者３０例,小剂量芬太尼辅以异氟醚和异丙酚维持麻醉,于麻醉后切皮瓣、开胸后体外循环前,体外循环３０分钟、６０分钟停机后２０仲,手术结束六个时点,观测氧供（ＤＯ２）、氧耗（ＶＯ２）氧摄取率（Ｏ２ＥＲ）、混合静脉血氧饱和度（ＳｖＯ２）、动脉血乳酸（ＢＬ）及血流动力学等变化。结果：和体外循环前相比,体外循环中和体外循环后除ＳｐＯ２     

Effects of urinary protease inhibitor on inflammatory response during on-pump coronary revascularisation. Effect of ulinastatin on inflammatory response

AIM: Cardiac surgery in patients undergoing cardiopulmonary bypass (CPB) provokes a vigorous inflammatory response with substantial clinical implications. Once the inflammatory response is triggered by CPB, leukocytes and platelets are activated by multiple stimuli. The administration of a urinary trypsin inhibitor (ulinastatin) during CPB is hypothesized to reduce cytokine release and platelet activation and to decrease pulmonary injury. We performed a prospective randomized study to investigate the influence of high-dose ulinastatin on cytokines and platelet activation and on respiratory function during and after CPB. METHODS: In this pilot, prospective, randomized and double-blinded study, 30 first-time three-vessel coronary artery disease (CAD) patients undergoing coronary artery bypass graft (CABG) were randomly divided into 2 groups: U group (n=15) received a total dose of 1000000 U ulinastatin and C group (n=15) received placebo. Blood samples were withdrawn from the central vein to measure polymorphonuclear neutrophil elastase (PMNE), tumour necrosis factor-alpha (TNF-a), interleukin-6 (IL-6) and interleukin-8 (IL-8), before induction, 30 min following clamping (T2), reperfusion 3 h (T3), reperfusion 6 h (T4) and reperfusion 12 h (T5). Whole blood samples were taken for CD62P immediately before induction (as baseline), at the end of CPB (before protamine administration), 1 h after heparin neutralization by protamine and 24 h after the operation. In addition, alveolo-arterial oxygen difference (A-aDO(2)) in pulmonary gas exchange function was calculated by obtaining arterial blood gas samples before and after CPB. RESULTS: There were no differences in preoperative parameters between the groups. After CPB, the levels of PMNE, TNF-alfa, IL-6 and IL-8 increased in both groups over baseline values (P<0.01). The levels of PMNE, TNF-alfa, IL-6 and IL-8 in U group were significantly lower than those in C group (P<0.05). No significant differences in CD62p expression between the 2 groups during CPB were found. A-aDO(2) in U group significantly decreased compared with C group (P<0.05) and the duration of mechanical ventilation was shorter than C group (P<0.05). CONCLUSION: Results suggest that ulinastatin may inhibit proinflammatory cytokine (PMNE, TNF-alfa, IL-6 and IL-8) release, reduce reperfusion lung injury and preserve pulmonary function but it fails to inhibit platelet activation and to prevent blood loss during CPB.     

钙、镁及甲状旁腺激素在心肺转流期间的动态变化

目的 观察心肺转流（CPB）期间钙、镁及甲状旁腺激素（PTH）的变化。方法 静脉血标本取自16例心内直视手术病人，采用原子吸收光谱法、离子选择电极法及化学发光分析方法于CPB期间不同时间点检测总钙、离子钙、总镁及PTH的含量。结果 CPB开始后钙、镁及PTH均降低（P＜0.05），至CPB结束时降至最低点（P＜0.01）。钙离子于术后第1天回复至术前水平，而总钙及总镁含量于术后第1天仍低于术前水平（P＜0.05）。PTH于CPB后2小时升高，于术后第1天升术前的2.6倍（P＜0.01）。结论 CPB期间发生了明显的低钙、低镁血症。钙－镁－甲状旁腺轴反应基本正常，但呈滞后现象。     

Effect of normothermic versus hypothermic cardiopulmonary bypass on cytokine production and platelet function

BACKGROUND: Proinflammatory cytokines and platelets play a key role in the systemic inflammatory response associated with cardiopulmonary bypass (CPB). The aim of this study was to evaluate the effects of both hypothermic and normothermic CPB on platelet activation, cytokine production, as well as their possible correlations. METHODS: Twenty patients who underwent CABG were randomly assigned into two groups receiving hypothermic and normothermic CPB. Blood samples were obtained through a venous catheter at 6 time points. The following parameters were measured: in vitro platelet aggregation, in vivo platelet activation, complete and differential blood cell counts, plasma soluble P-selectin levels, plasma IL-6, IL-1beta and TNFalpha levels. RESULTS: The results demonstrated that platelet abnormalities could be observed to a greater extent during hypothermic rather than normothermic CPB. The occurrence of in vivo platelet activation was suggested by the presence of a significantly increased percentage of platelets expressing CD62P on their surface, as well as by a decreased in vitro platelet aggregation induced by different agonists. Complete and differential blood cell counts showed no substantial decrease in platelet number without differences between groups. The results obtained also showed the presence of a significant release of sP-selectin during CPB, as well as a more pronounced increase of plasma sP-selectin levels in patients undergoing hypothermic compared to normothermic CPB. A comparison of cytokine levels demonstrated a significant elevation of plasma IL-6 levels during either hypothermic or normothenmic CPB, paralleling the neutrophil rise, while no differences were observed for TNF-alpha levels. Conversely, plasma IL-1beta levels were significantly elevated during hypothermic, but not during normothermic CPB. CONCLUSIONS: Hypothermic CPB is responsible for a greater platelet activation and endothelial dysfunction than normothermic CPB, leading to more profound changes in the hemostatic and inflammatory systems, which, in turn, might be responsible for the higher incidence of postoperative complications reported during hypothermic CPB.