乌司他丁和氨甲环酸在体外循环中对血小板的影响

 目的探讨氨甲环酸、乌司他丁在心肺转流(CPB)中对血小板的保护作用及其临床意义。方法在41例心脏手术患者CPB中,随机分别加入乌司他丁(15例)、氨甲环酸(14例)及生理盐水(对照组,12例),在全身肝素化前,肝素化后10min,转流30min,转流结束肝素中和后10min及术后24h分别检测血小板数(PLT)、血小板最大聚集率(PAGM)及血小板膜糖蛋白(CD41a,CD42a,CD61,CD62p)阳性表达率和平均荧光强度(MFI)的变化。结果肝素化前3组各项指标均无明显差异。肝素化后10minCD62p阳性表达率和MFI,两用药组明显低于对照组(分别为P<0.05和P<0.01);转流30min和转流结束肝素中和后10min,两用药组PLT,PAGM及CD42a的MFI与对照组相比明显增高(分别为P<0.05,P<0.01和P<0.001),而CD41a,CD61,CD62p的MFI和CD62p阳性表达率明显减低(分别为P<0.05,P<0.01和P<0.001);术后24h,两用药组PLT,PAGM及CD62p的MFI和CD62p阳性表达率与对照组相比仍有明显差异(分别为P<0.01和P<0.001)。对照组术后24h与肝素化前比较,PLT,PAGM及CD42a,CD61,CD62p的MFI和CD62p阳性表达率均存在明显差异(分别为P<0.05,P<0.01和P<0.001);两用药组术后24h与肝素化前比较,只有PAGM及CD62p阳性表达率存在明显差异(分别为P<0.05和P<0.001)。两用药组同一时间点比较,只有术后24h时间点的CD62p阳性表达率有明显差异(P<0.001)。结论在体外循环中乌司他丁与氨甲环酸均有一定的血小板保护作用,保护作用两者差异很小,但氨甲环酸的价格便宜,值得推广使用。体外循环中为了更好地血液保护,仍应尽可能缩短CPB时间。

Effects of ulinastatin and traneamic acid on platelet during cardiopulmonary bypass

OBJECTIVE To investigate the effects and clinic significance of ulinastatin and traneamic acid on platelet during cardiopul-monary bypass. METHODS 41 patients with cardiopulmonary bypass were divided into three groups at random-15 patients received ulinastatin injection, 14 patients were treated with traneamic acid, and 12 patients were given saline injection, PAGM, platelet membrane glycoproteins (CD41a,CD42a,CD61 ,and CD62p) were measured before heparirization, 10 and 30 minutes after bypass, 10 minutes after heparin neutralization, and 24 h after operation.RESULTS Before heparirization,there was no difference among three groups. 10 Minutes after heparirization, the expression rate and the mean fluorescence intensions (MFI) of CD62p in the two groups injected with ulinastatin and traneamic acid were well below those of the control group(P < 0.05, P < 0.01,respectively) ; 30 minutes after bypass and 10 minutes after heparin neutralization platelet, PAGM and MFI of CD42a were well above those of the control group(P < 0.05, P < 0.01 and P < 0.001,respectively), but the expression rate of CD62p and MFI of CD41a, CD61 and CD62p considerably declined (P < 0.05, P < 0.01 and P < 0.001, respectively) . Compared with the control group. 24 h after operation platelet, PAGM, MFI of CD62p and the expression rate of Cd62p of the two groups injected with ulinastatin and traneamic acid had still remarkable difference(P < 0.01 and P < 0.001,respectively) .In the control group,after operation platelet, PAGM, MFI of CD42a, CD61 and CD62 and the expression rate of CD62p before heparirization had significant difference from that(P < 0.05, P < 0.01 and P < 0.001,respectively) . In the two groups injected ulinastatin and traneamic acid, PAGM and the expression rate of CD62p before heparirization were distinct from that after operation(P < 0.05, P < 0.001, respectively) . CONCLUSION During cardiopulmonary bypass, ulinastatin and traneamic acid have a protecting effect on platelet.