体外循环下心瓣膜置换术患者血小板及凝血功能的变化及普鲁泊福对其的影响  

Changes of platelets and coagulation function during cardiopulmonary bypass in patients undergoing cardiac valvular replacement surgery and effect of propofol on the changes

作　　者：刘若杉[1] 朱文忠[1] 邓小明[1] 许涛[1] 

机构地区：[1]第二军医大学长海医院麻醉科,上海200433

出　　处：《第二军医大学学报》2005年第6期671-674,共4页Academic Journal of Second Military Medical University

摘　　要：目的:观察体外循环(CPB)下心脏瓣膜置换手术中患者血小板与凝血功能的变化及普鲁泊福对其的影响。方法:ASAⅡ～Ⅲ级择期心脏瓣膜置换手术患者30例,随机分为对照组(n=15)和普鲁泊福组(n=15)。对照组应用咪达唑仑0.05mg/kg、芬太尼0.01mg/kg、维库溴铵0.1～0.2mg/kg行麻醉诱导,术中以0.5%～1.5%异氟烷及芬太尼、哌库溴铵维持麻醉;普鲁泊福组应用咪达唑仑0.05mg/kg、芬太尼0.005～0.01mg/kg、普鲁泊福1.5mg/kg、维库溴铵0.1～0.2mg/kg行麻醉诱导,术中以静注普鲁泊福4～5mg/(kg·h)、芬太尼、哌库溴铵和0.5%～1.0%异氟烷维持麻醉。采用Sonoclot凝血与血小板功能分析仪分别测定麻醉前、诱导后5min、CPB转流前、CPB结束后10min、手术结束时5个时间点全血激活凝固时间(SonACT)、凝血速率、血小板功能(PF)、凝血达到高峰时间(TP),同时观察血小板(PLT)计数、血浆凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)的变化。结果:与麻醉前相比,诱导后和转流前2组SonACT、PF、凝血速率、TP及常规凝血试验各项指标均无显著差异;CPB结束后10min和手术结束时2组PF显著降低(P<0.01),SonACT、凝血速率、TP、PT、APTT明显延长(P<0.01),PLT计数明显减少(P<0.01);2组间各个时间点的指标相比较无显著差异。Objective:To investigate changes of platelets and coagulation function in patients undergoing cardiac valvular replacement surgery during cardiopulmonary bypass(CPB).Methods: Thirty patients scheduled for elective cardiac valvular replacement were equally randomlized to 2 groups: control group and propofol group. In control group anesthesia was induced with midazolam 0.05 mg·kg -1,fentanyl 0.01 mg·kg -1 and vecuronium 0.1-0.2 mg·kg -1, and maintained with isoflurane,fentanyl and vecuronium. In propofol group anesthesia was induced with midazolam 0.05 mg·kg -1,fentanyl 0.005-0.01 mg·kg -1,propofol 1.5 mg·kg -1 and vecuronium 0.1-0.2 mg·kg -1, and propofol 4-5 mg·kg -1·h -1 was administered during operation with isoflurane,fentanyl and vecuronium. Blood samples were taken from jugular vein to assay SonACT, clot rate and platelet function with Sonoclot ananlysis, and to measure platelet count, PT and APTT before anesthesia, 5 min after induction,before CPB,10 min after CPB and at the end of operation.Results: Compared with those before anesthesia, PF, clot rate, platelet count, PT and APTT in both groups significantly decreased 10 min after CPB and at the end of operation(P<0.01), while there were no differences in these values between the 2 groups at different time points. Conclusion: The results of our study suggest that CPB might be the main factor influencing platelet function and coagulation during cardiac valvular replacement surgery. Propofol, 1.5 mg·kg -1 for induction and 4-5 mg·kg -1 for maintenance has no obvious influence on platelet function during cardiac surgery.

关 键 词：心肺转流术 血小板 凝血 普鲁泊福 

分 类 号：R654.2[医药卫生—外科学]