心脏手术中凝血及血小板功能的变化

The changes in coagulation and platelet function during cardiac surgery using SONOCLOT

目的 应用Sonoclot凝血及血小板功能分析仪 (SCT)检测风心病和冠心病患者心脏手术中凝血与血小板功能的变化。方法 ASAⅡ～Ⅲ级心脏手术患者 30例 ,其中瓣膜置换术 15例 (瓣膜组 ) ,冠脉搭桥术 15例 (CABG组 )。采用静吸复合全身麻醉。分别于麻醉前 (T1)、诱导后 (T2 )、肝素化后 (3mg/kg) (T3 )、CPB结束鱼精蛋白拮抗后 5min(T4)抽血 ,检测激活全血凝固时间 (sonACT)、凝血速率和血小板功能 ,并在T1和T4行血小板计数。结果 与T1相比 ,T2 的凝血速率明显升高 (P <0 0 5 ) ;T3 的sonACT明显延长 (P <0 0 1) ,凝结率和血小板功能显著下降 (P <0 0 1) ;T4的sonACT明显延长、血小板功能明显升高 (P <0 0 1) ,血小板计数显著降低 (P <0 0 1)。另外 ,瓣膜组T3 的sonACT明显长于CABG组 (P <0 0 5 ) ;CABG组T1的凝血速率 (30 32± 3 0 7凝血信号 /min)明显高于瓣膜组(2 4 15± 4 13凝血信号 /min) (P <0 0 5 )。CABG组T4的血小板功能 (2 83± 0 90 )明显高于瓣膜组(2 0 0± 0 81) (P <0 0 5 )。结论 心脏手术中监测凝血及血小板功能具有一定价值 ,尤其在CPB结束后。瓣膜组患者的凝血及血小板功能虽在正常范围内但均低于冠心病患者。

Objective This study was designed to evaluate the change in coagulation and platelet function during cardiac surgery using SONOCLOT(SCT), a new coagulation and platelet function analyser which can analyse the whole process of coagulation including platelet function , fibrin formation and fibrinolysis with only 0 4ml of whole blood Methods Thirty ASA Ⅱ Ⅲpatients scheduled for cardiac surgery were studied 15 patients underwent valve replacement (group V) and another 15 patients coronary artery bypass graft (CABG, groupC) under combined intravenous and inhalation anesthesia Anesthesia was induced with midazolam 0 05mg·kg -1 ,fentanyl 5 10μg kg -1 or propofol 1 1 5mg·kg -1 and vecuronium 0 1 0 2mg·kg -1 and maintained with isoflurane(0 8 1 5MAC) supplemented with intermittent boluses of propofol and fentanyl ECG,SpO 2, P ET CO 2, BP, CVP, PAP, HCT and T were monitored during operation And dopamine, adrenaline, nitroglycerin, milrinone and other vasoactive drugs were used to maintain hemodynamic stability Blood samples were taken before anesthesia (T 1), after induction (T 2), after heparinization 3mg· kg -1 ( T 3) and 5min after protamine administration (T 4) for determination of ACT, clot rate and platelet function using SONOCLOT analysis Platelet counts were checked at T 1 and T 4 Results CPB time was less than 2h in all 30 patients Clot rate was significantly faster at T 2 than at T 1(P<0 05) At T 3 ACT was significantly reduced (P<0 01) At T 4 ACT was significantly prolonged and platelet count significantly reduced (P<0 01) At T 1 clot rate was significantly faster in group C than that in group V At T 3 ACT was significantly longer in group V than that in group C At T 4 platelet function was significantly better in group C than that in group V Conclusions SONOCLOT is useful in monitoring coagulation and platelet function during cardiac surgery with CPB Although coagulation and platelet function are normal in patients undergoing valve replacement, these values are lower than those in patients undergoing coronary artery bypass graft