体外循环围术期血细胞流变特性及抑肽酶的影响

目的　研究体外循环 (ECC)冠状动脉旁路移植术围术期患者血细胞流变行为及动态变化特征 ,探讨术后并发症发生的细胞机制 ,观察抑肽酶对其的影响。　方法　采集 2 0例 ECC下冠状动脉旁路移植术患者的外周血于麻醉诱导前、转流开始后 30分钟、主动脉开放后 10分钟和术后第 1天、2天、4天和 7天制成活血片 ,用布氏显微电视系统分析活血细胞流变行为 ,并观察外周血细胞计数、术后动脉血氧饱和度及并发症。　结果　 ECC开始后 30分钟两组患者血细胞流变行为即明显变化 ,术后第 1～ 2天变化最为明显 ,并持续数天 ,第 7天始逐渐恢复正常。实验组白细胞和血小板的变化程度在各个时点都明显减轻 (P<0 .0 1) ,术后第 1天白细胞活化率和聚集率达到最高峰 ,术后第 1天血小板聚集率和活化率两组差异有显著性 (P<0 .0 1)。两组术后 2 4小时胸腔引流量及拔呼吸管时间亦有明显差异(P<0 .0 5 )。　结论　ECC围术期存在血小板质、量异常 ,白细胞活化、聚集等细胞形态学和流变学异常变化 ,是术后患者有出血倾向、肺功能障碍的重要参与机制 ,而抑肽酶具有较好的保护作用。

Effects of Aprotinin on Change of the Rheological Behavior of Blood Cells During Extracorporeal Circulation Perioperative Period

Objective To study the dynamical changes of rheological behavior of blood cells in extracorporeal circulation(ECC) perioperative period, and investigate the blood protective effects of aprotinin. Methods Twenty patients underwent coronary artery bypass grafting (CABG) were randomly divided into control group( n =10) and experimental group( n=10) , the latter received aprotinin. By Bradford microscopy TV system with high amplification and variable projection, the rheological behavior and counts of peripheral blood cells was observed at before anesthesia, 30 minutes after ECC, 10 minutes after open aortic clamp, the 1st, 2nd, 4th and 7th day after operation respectively. Simultaneously, the arterial oxygen saturation (SaO 2) and complications were noted. Results After 30 minutes of ECC, the rheological behavior abnormalities of blood cells were notable for few days, and recovered from the 7th day. The changes reached the peak in the 1 2 day after operation. Compared with the control group, the ratio of platelet aggregation increased, white blood cell activation and aggregation decreased in the experimental group, the platelet count had no significant change in two groups. Conclusion In the perioperative period of ECC, the rheological behavior changes of white blood cell and platelet were notably abnormal which maybe responsible for postoperative bleeding tendency and pulmonary disfunction, whereas, the aprotinin had better protective effect.