应用Sonoclot评价不同浓度肝素加压冲洗液对凝血和血小板功能的影响

Effects of different concentrations of pressurized-heparin flushing fluid on coagulation and platelet function monitored by Sonoclot analyzer

目的采用Sonoclot凝血和血小板功能分析仪评价不同浓度肝素加压冲洗液对患者围术期凝血和血小板功能的影响。方法选择3 h以上择期胃肠道恶性肿瘤全麻手术患者60例,男44例,女16例,年龄18~75岁,BMI 18~29 kg/m^2,ASAⅠ—Ⅲ级,根据加压动脉冲洗液中肝素浓度的不同,采用随机数字表法分成三组:肝素2 U/ml组(H 1组)、肝素4 U/ml组(H 2组)和对照组(C组)。H 1组使用肝素浓度为2 U/ml注入500 ml生理盐水;H 2组使用肝素浓度为4 U/ml注入500 ml生理盐水;C组使用500 ml生理盐水。三组冲洗液放置于压力为300 mmHg的加压袋中。分别于右颈内静脉穿刺置管后10 min(T 0)、手术开始后2 h(T 1)和术毕(T 2)抽取颈内静脉血1 ml,采用Sonoclot分析仪对血样行玻璃珠激活凝血时间(gbACT)、凝血速率(gbCR)和血小板功能(gbPF)检测。分别于术前24 h、术后24、48 h抽取静脉血测定血小板计数(Plt)。记录术中手位置调整次数、手动冲洗动脉次数、术中输液量、出血量、尿量和术后48 h腹腔总引流量。于术后24 h内随访并记录渗血、血肿和感染等动脉穿刺局部并发症情况。结果与T 0时比较,T 1时H 1组gbPF、T 2时H 2组gbPF均明显降低(P<0.05),但其数值仍在正常范围内。不同时点三组gbACT和gbCR差异均无统计学意义。与术前24 h比较,术后24 h三组Plt明显升高(P<0.05)。与术后24 h比较,术后48 h三组Plt明显降低(P<0.05)。不同时点三组Plt差异均无统计学意义。三组术中手位置调整次数、手动冲洗动脉次数差异均无统计学意义。三组围术期未发生严重不良反应。结论浓度为2 U/ml或4 U/ml的肝素稀释液和生理盐水均可用于有创动脉压监测管道的加压连续冲洗。

Objective To evaluate effects of different concentrations of pressurized-heparin flushing fluid on coagulation and platelet function monitored by Sonoclot analyzer in perioperative patients.Methods Sixty patients,44 males and 16 females,aged 18-75 years,BMI 18-29 kg/m^2,ASA physical statusⅠ-Ⅲ,undergoing elective gastrointestinal cancer surgery over 3 h under general anesthesia,were enrolled.Patients were divided into three groups using random number table according to different heparin concentrations in pressurized flushing of arterial line:heparin 2 U/ml(group H 1),heparin 4 U/ml(group H 2)and control group(group C).Heparin with a concentration of 2 U/ml in 500 ml of normal saline was used in group H 1,heparin with a concentration of 4 U/ml in 500 ml of normal saline was used in group H 2,500 ml of normal saline was used in group C.The three groups of heparin dilution or saline were placed in a pressure bag with a pressure of 300 mmHg.Blood samples of 1 ml were taken from right internal jugular vein at 10 min after the vein puncture(T 0),2 h after surgery(T 1)and at the end of surgery(T 2)for measurement of glass bead Activated Clotting Time(gbACT),glass bead Clot Rate(gbCR)and glass bead Platelet Function(gbPF)using Sonoclot coagulation and platelet function analyzer.Blood samples were also collected from veins 24 h before surgery,24 h after surgery and 48 h after surgery for determination of platelet count(Plt).The frequencies of hand positional changes and manual artery flushing during surgery,intraoperative infusion volume,blood loss,urine volume,and total intraperitoneal drainage in 48 h after surgery were recorded.Follow-up was performed and local complications of arterial puncture such as bleeding,hematoma and infection were recorded within 24 h after surgery.Results Compared with T 0,gbPF at T 1 in group H 1 and at T 2 in group H 2 were both significantly decreased(P<0.05)but still in normal ranges.There were no significant differences of gbACT and gbCR values between the three groups at each time point.Compared with 24 h before surgery,Plt significantly increased in the three groups at 24 h after surgery(P<0.05).Compared with 24 h after operation,Plt significantly decreased in the three groups at 48 h after surgery(P<0.05).There were no significant differences in Plt values among the three groups at each time point.There were no significant differences in the frequencies of hand positional changes and manual artery flushing during surgery between the three groups.No serious complications occurred in the three groups.Conclusion Heparin dilution with a concentration of 2 U/ml or 4 U/ml and normal saline can be used for pressurized continuous flushing of invasive arterial pressure monitoring tube.