血栓弹力图评价不同预充液对血小板功能的影响  

Evaluation of the effect of different cardiopulmonary bypass priming solution on platelet function using thromboelastography

作　　者：郑林[1] 吴明营[2] 赵凤华[3] 张燕搏[1] 齐弘炜[2] 

机构地区：[1]中国医学科学院,北京协和医学院,阜外心血管病医院小儿心脏中心PICU,北京100037 [2]首都医科大学附属北京同仁医院心血管中心心外科,北京100176 [3]首都医科大学附属北京同仁医院体外循环科,北京100176

出　　处：《中国体外循环杂志》2013年第4期220-223,251,共5页Chinese Journal of Extracorporeal Circulation

摘　　要：目的应用血栓弹力图(TEG)评价体外循环(CPB)不同预充液对血小板功能的影响,为临床合理选用胶体预充液提供理论依据。方法选取北京同仁医院2010年7月至12月CPB下心脏手术的患者30例。随机分为白蛋白组(n=10)、盈源(6%羟乙基淀粉200/0.5)组(200/0.6)(n=10)和万汶组(130/0.4)(n=10)。预充胶体:白蛋白组为白蛋白20g+万汶500ml,万汶组为万汶1500ml,盈源组为盈源1500ml。分别于肝素化前10 min及鱼精蛋白中和肝素10 min后采血,采用TEG及Platelet MappingTM系统检测凝血和血小板功能,监测TEG常规指标(R值、K值、α角、MA值),同时测定激活全血凝固时间(ACT)及血常规。结果三组患者一般情况、肝素化前血红蛋白浓度、红细胞计数及血小板计数、CPB时间、主动脉阻断时间差异不显著(P>0.05)。CPB后TEG参数(R值、K值、α角、MA值等)变化明显,提示凝血功能异常。蛋白组关胸止血时间相比另外两组缩短。组内比较,各组鱼精蛋白中和后R值、K值及α角与其肝素化前10min相比均无显著差异(P>0.05),但MA值及血小板抑制率却有显著差异(P<0.05)。组间比较三组之间肝素化前10 min ACT值、TEG参数值、鱼精蛋白中和后R值、K值及α角差异不显著(P>0.05),但MA值、血小板抑制率差异显著(P<0.05)。结论预充液添加蛋白对血小板功能影响较小,TEG能够检测CPB后凝血功能的变化,其中Platelet MappingTM参数能更为精确地反映血小板功能,是一种特异有效的床旁检测方法。Objective To evaluate the effect of different cardiopulmonary bypass(CPB) priming solution on platelet function using thromboelastography(TEG) and Platelet MappingTMsystem.Methods Between July 2010 and December 2010,30 consecutive patients received open heart surgery with CPB and volunteered for the experiment in TongRen hospital.Patients were randomly divided into albumin group(n=10),Ying Yuan(200/0.6) group(n=10) and Voluven(130/0.4) group(n=10).Albumin group got 20g albumin and Voluven 500ml for colloid filling,and Voluven group got for 1500ml Voluven colloid filling,Ying Yuan group got for filling colloid 1500ml.Coagulation function and platelet function were studied with TEG and Platelet Mapping assay.TEG conventional index included R value,K value,alpha horn and MA value,also activated clotting time(ACT) and blood routine analysis were analysed at 10 minutes before heparinization and 10mins after protamine.Results The general condition,hemoglobin before heparinization,red blood cell count,platelet count,CPB time and aorta cross clamping time of patients had no significantly differences between three groups(P>0.05).After CPB,TEG parameters(R value,K value,alpha horn,MA value,etc.) indicating a marked change coagulant function abnormality.Sternal hemostasis and closure time in protein group shortened compared to the other two groups.Compared with those at 10 min before heparinization,after protamine,the R value,K value and alpha horns of patients in three groups had no significant difference(P>0.05),while MA value and platelet inhibition rate had significant differences(P<0.05).Meanwhile,in the three groups,ACT and TEG parameter value at 10min before haperinize and R value,K value and alpha Angle after protamine of all patients had no significant difference(P>0.05),while the MA value and platelet inhibition rate had significant difference(P<0.05).Conclusion Priming solution with protein has less influence on platelet function.TEG and Platelet Mapping are able to diagnose early coagulation dysfunction after CP

关 键 词：血栓弹力图 血小板功能 体外循环 预充液 

分 类 号：R614[医药卫生—麻醉学]