短时间体外循环对血小板膜受体的影响

INFLUENCE OF SHORT CARDIOPULMONARY BYPASS ON PLATELET MEMBRANE RECEPTORS

为探讨心肺转流（ＣＰＢ）体外循环期间血小板的灭活机制，用流式细胞术对４０例先天性心脏房、室间隔缺损患者在ＣＰＢ下行心内修补术时的血小板膜受体ＣＤ４１ａ、ＣＤ４２ｂ、ＣＤ６２ｐ和ＣＤ６３的变化，同时与本组患者试管内血小板膜受体进行比较。在ＣＰＢ中血小板总数明显下降，从术前的（３１０±９１）×１０６／Ｌ降至术后的（１８１±４４）×１０６／Ｌ，ＣＤ４１ａ无明显变化，ＣＤ４２ｂ明显降低，ＣＤ６２ｐ和ＣＤ６３明显增加，而试管内试验与之不符。结果表明，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受体，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。

To elucidate the mechanism of platelet dysfunction during short cardiopulmonary bypass (CPB), we performed a study on the platelet membrane receptors (PMR). CD41a, CD42b, CD62p and CD63 were measured during operation by flow cytometry in 40 patients with atrial or ventricular septal defect and compared with PMR ex vivo during CPB. A significant drop in platelet count was observed from preoperative (310±91)×10 6/L to postoperative (181±44)×10 6/L; CD41a did not drop significantly, CD42b dropped significantly, CD62p and CD63 increased significantly. These alterations were asymmetrical compared with PMR ex vivo . During CPB, there was decrease in adhesion agglutination as well as increase of adhesion agglutination of PMR. The coagulative dysfunction of blood was related to platelet count drop, hypothermia and after effect of heparin.