心肺转流术对凝血及血小板功能的影响

Effect of cardiopulmonary bypass on coagulation and platelet function

目的 应用Sonoclot凝血及血小板功能（Pf）分析仪检测心脏手术心肺转流术（CPB）对Pf的影响.方法 麻醉前病情分极Ⅰ～Ⅲ级,心脏手术患者24例,其中瓣膜置换术12例,室缺修补术12例.采用静吸复合全身麻醉,分别于麻醉诱导后（T1）、肝素化后10 min（3 mg/kg）（T2）、CPB后10 min（T3）及鱼精蛋白拮抗后10 min（T4）抽血,检测激活全血凝固时间（sonACT）、凝血速率（clot rate）和Pf并进行血小板计数（PLT）.结果 与T1相比,T2点的clot rate及sonACT明显升高（P＜0.01）,PLT和Pf降低（P＜0.05）;T3点的sonACT明显延长,clotrate和Pf显著下降,PLT明显降低（P＜0.01）;T4点的sonACT明显延长,Pf明显升高（P＜0.01）,clot rate无明显变化,PLT显著降低（P＜0.01）.结论 CPB可显著影响Pf,心脏手术中监测凝血及Pf有重要的临床意义.

Objective To study the effect of cardiopulmonary bypass （CPB） on coagulation and platelet function （Pf） using Sonoclot and Pf Analyzer. Methods 24 patients graded ASA Ⅰ-Ⅲwere enrolled in this study, in which 12 patients underwent valve replacement and the other 12 patients underwent ventricular septal defect surgery. All cases received combined general anaesthesia. The SonACT, clot rate, platelet function and platelet count were measured at post-induced（T1）, 10 minutes after heparinization（T2）, 10 minutes after CPB（T3） and 10 minutes after protamine administration（T4）respectively. Results Compared with that at T1, the clot rate and sonACT were higher, platelet count and platelet function was lower at T2; the sonACT was significantly prolonged, the clot rate, platelet function and platelet count markedly reduced at T3 ; the sonACT was significantly prolonged, platelet function was higher and platelet count markedly reduced at T4. Conclusion CPB can affect platelet function and it is important to monitor coagulation and platelet function during cardiac surgery.