采用血栓弹力图监测冠状动脉旁路移植术对血小板功能的影响

目的用血栓弹力图(TEG)监测体外循环下冠状动脉旁路移植术(CABG)与非体外循环下冠状动脉旁路移植术(OPCAB)对患者凝血及血小板功能的影响。方法连续选取2012年4月至12月患者48例,前瞻性随机分为CABG组(n=28)和OPCAB组(n=20)。分别于肝素化前5 min及鱼精蛋白中和后10 min经中心静脉导管采血,采用TEG及Platelet MappingTM系统检测两组患者的凝血和血小板功能,同时测定激活全血凝固时间(ACT)及血常规。记录术后出血量及同种异体输血量。结果两组患者鱼精蛋白中和后相比肝素化前ACT、R值、K值及α角均无显著差异;但MA值、血小板抑制率(INHADP、INHAA)差异显著(P<0.05)。肝素化前两组患者的ACT值及TEG参数值相比无显著差异;鱼精蛋白中和后两组患者的R值、K值及α角相比差异不显著,但MA值、INHADP、INHAA相比差异显著(P<0.05)。术后OPCAB组引流量及输血量明显少于CABG组(P<0.05)。结论血小板功能受损是导致CABG凝血功能受损的主要原因。与CABG相比,OPCAB有益于保护血小板和凝血功能,减少术后异常出血及输血量。

Changes of coagulation and platelet function in patients undergoing coronary ar-tery bypass grafting

Objective This study was designed to evaluate the changes of coagulation and platelet function in patients undergoing coronary artery bypass grafting with or without cardiopulmonary bypass（ CPB） by thromboelastography（ TEG） and platelet mapping. Methods Between April 2012 and December 2012,48 consecutive patients received coronary artery bypass. They were randomly assigned to two groups. 20 underwent off-pump coronary artery bypass（ OPCAB group） and 28 underwent coronary artery bypass grafting（ CABG） with CPB（ CCABG group）. Blood samples were collected at 5 minutes before heparinization and 10 minutes after heparin neutralization. Coagulation function was studied with TEG and platelet mapping assay,activated clotting time（ ACT） and blood routine analysis. Postoperative blood loss and transfusion were recorded. Results There were no significant differences in TEG assay and ACT between groups before heparinization. After heparinization,R-time,K-time and α-angle were insignificantly different between the two groups,while maximal amplitude and inhibition of platelet were significantly different. Furthermore,R-time,K-time was slightly increased,and α-angle（ α） was slightly decreased after neutralization,but maximal amplitude was significantly lower and inhibition of platelet was significantly increased in the CCABG groups（ P 〈0.05）. Postoperative blood loss and transfusion in OPCAB group were both lower than those in CCABG group. Conclusion Impairment of platelet function contributes primarily to the postoperative dysfunction of coagulation. Compared with CCABG,OPCAB is in favor of protection of platelet function and coagulation,helping lower postoperative bleeding and transfusion volume.