肝素涂层管道对体外循环中血小板的保护作用

Protective effect of heparin-coated circuits on the platelet during cardiopulmonary bypass

目的 探讨常规剂量肝素体外循环 (CPB)下使用肝素涂层CPB管道 (HCC)对血小板的影响。方法 机械瓣膜置换术患者随机分为HCC组 (n =8)和对照组 (n =1 5)。分别在CPB前、CPB 60min、肝素中和后 30、60min及手术后 1 2h测定血小板计数 (PLT) ,血浆α颗粒膜蛋白 1 4 0 (GMP 1 4 0 )的浓度及手术后 1 2h出血量。利用电子显微镜观察两组转流后微栓过滤网上沉积物的附着情况。结果 对照组PLC在转流中、后显著低于HCC组 ,差异有显著性 (P <0 .0 5) ,且血浆GMP 1 4 0浓度在转流 60min、转流中和后 30、60min显著高于HCC组 ,差异有显著性(P <0 .0 5) ,但手术后 1 2h差异无显著性 (P >0 .0 5) ;HCC组手术后 1 2h出血量较对照组少 ,差异有显著性 (P <0 .0 5) ;HCC组动脉过滤网表面光洁 ,网眼边缘清晰 ,偶见白细胞和血小板附着 ;对照组动脉过滤网表面可见纤维蛋白沉积 ,网眼边缘模糊 ,有大量白细胞及少数活化血小板粘附。结论 HCC在CPB中对血小板具有保护作用 。

Objective To observe the protective effect of heparin coated circuits (HCC) on the platelet function during cardiopulmonary bypass.Methods Twenty three patients undergoing heart valve replacement were studied.The system heparin dose was 3?mg/kg in the control group (n=15) and heparin coated circuits in the HCC group (n=8).Platelet count and a granule membrane protein 140 (GMP 140) concentrations were determined before CPB, at 60?min of CPB, at 30 and 60?min after protamine administration,at first 12?h of CPB,respectively.At end of CPB the arterial filters in the circuits were observed by electron microscopy.The amount of first 12?h postoperative blood loss were measured.Results There was a significant reduction of platelet loss during and after CPB in the HCC group in contrast to the control group (P<0.05).GMP 140 in the HCC group was lower than in the control group during CPB (P<0.05).During the first 12?h,postoperative blood loss was reduced in the HCC group as compared with that in the control group.Electron microscopy observation showed that in the HCC group the filter meshes and their fringes were clear and fragments of floccules could be seen occasionally.No cells adhered or a few cells adhered onto their surfaces,whereas several cellular and fibrous components were found adhering onto the surfaces of the filter mesh obtained from the control group.Conclusion Heparin coated circuits might reduce the platelet loss and activation during CPB and improve hemocompatibility of cardiopulmonary bypass equipment.